Basic Information
| Provider Information | |||||||||
| NPI: | 1558596338 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THROCKMORTON COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THROCKMORTON COUNTY NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 700 | ||||||||
| Address2: | |||||||||
| City: | THROCKMORTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764830700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9408493081 | ||||||||
| FaxNumber: | 9408499601 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N MINTER AVE | ||||||||
| Address2: | |||||||||
| City: | THROCKMORTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764834900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9408492861 | ||||||||
| FaxNumber: | 9408496011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 08/05/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | TREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COUNTY JUDGE | ||||||||
| AuthorizedOfficialTelephone: | 9408493081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001017105 | 05 | TX | MEDICAID | 004246 | 01 | TX | FACILITY ID | OTHER |