Basic Information
| Provider Information | |||||||||
| NPI: | 1477091429 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TYLER COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | OAKWOOD MANOR NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W BLUFF ST | ||||||||
| Address2: | |||||||||
| City: | WOODVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759794738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092836400 | ||||||||
| FaxNumber: | 4092835961 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VIDOR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776625745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097693692 | ||||||||
| FaxNumber: | 4097691390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4092836400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.