Basic Information
| Provider Information | |||||||||
| NPI: | 1497172514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHENS MEMORIAL HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MULBERRY MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1670 W LINGLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | STEPHENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764011830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2549682158 | ||||||||
| FaxNumber: | 2549656971 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 W 7TH STRRET SUITE 430 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173396177 | ||||||||
| FaxNumber: | 8173396178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 05/31/2016 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8173396177 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRINITY HEALTHCARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.