Basic Information
| Provider Information | |||||||||
| NPI: | 1417005141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRAHAM CC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 1ST ST | ||||||||
| Address2: | |||||||||
| City: | GRAHAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764503603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405498787 | ||||||||
| FaxNumber: | 9405210355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 1ST ST | ||||||||
| Address2: | |||||||||
| City: | GRAHAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764503603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405498787 | ||||||||
| FaxNumber: | 9405210355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9405498787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 114203 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.