Basic Information
| Provider Information | |||||||||
| NPI: | 1285762286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRATFORD HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PLAINVIEW HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BEAVER ROAD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063962844 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2510 W 24TH ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790721808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062965584 | ||||||||
| FaxNumber: | 8062966526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 11/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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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 | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001015051 | 05 | TX | MEDICAID |