Basic Information
| Provider Information | |||||||||
| NPI: | 1154546836 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NOCONA HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SENIOR CARE HEALTH & REHABILITATION CENTER-WICHITA FALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1413 E INTERSTATE 30 STE 7 | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750434598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723039000 | ||||||||
| FaxNumber: | 9723039992 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 MIDWESTERN PKWY | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763022210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407675500 | ||||||||
| FaxNumber: | 9402354000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND CHIEF FINANCIAL | ||||||||
| AuthorizedOfficialTelephone: | 9723039000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001026671 | 05 | TX | MEDICAID | 001015058 | 05 | TX | MEDICAID |