Basic Information
| Provider Information | |||||||||
| NPI: | 1154319853 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STRATFORD HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAGE HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1189 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790841189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063962844 | ||||||||
| FaxNumber: | 8063962086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 N 15TH ST | ||||||||
| Address2: | |||||||||
| City: | LAMESA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793313025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068722141 | ||||||||
| FaxNumber: | 8068722299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8063962844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 004672 | 01 | TX | FACILITY ID NO. | OTHER | 001026295 | 05 | TX | MEDICAID |