Basic Information
| Provider Information | |||||||||
| NPI: | 1164856803 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILDRESS COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | TULIA HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 S AUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | TULIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790883025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069954810 | ||||||||
| FaxNumber: | 8069952263 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 S AUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | TULIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790883025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069954810 | ||||||||
| FaxNumber: | 8069952263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | HOLCOMB | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9409379178 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/24/2021 | ||||||||
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 | 004559 | 01 | TX | MEDICAID VENDOR ID | OTHER | 001025489 | 05 | TX | MEDICAID |