Basic Information
Provider Information | |||||||||
NPI: | 1376011569 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HAMILTON COUNTY HOSPITAL DISTRICT | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SUNFLOWER PARK HEALTH CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4150 INTERNATIONAL PLAZA | ||||||||
Address2: | SUITE 600 | ||||||||
City: | FT WORTH | ||||||||
State: | TX | ||||||||
PostalCode: | 761094831 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8173488959 | ||||||||
FaxNumber: | 8173480466 | ||||||||
Practice Location | |||||||||
Address1: | 1803 HIGHWAY 243 EAST | ||||||||
Address2: |   | ||||||||
City: | KAUFMAN | ||||||||
State: | TX | ||||||||
PostalCode: | 751424118 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9729327776 | ||||||||
FaxNumber: | 9729328916 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/06/2018 | ||||||||
LastUpdateDate: | 10/09/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOOPER | ||||||||
AuthorizedOfficialFirstName: | GRADY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 2543861600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/09/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   |   | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.