Basic Information
| Provider Information | |||||||||
| NPI: | 1619298908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMILTON COUNTY HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | CARE NURSING & REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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: | 200 COUNTY ROAD 616 | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768023294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256465521 | ||||||||
| FaxNumber: | 3256432790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOOPER | ||||||||
| AuthorizedOfficialFirstName: | GRADY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2543861600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 004124 | 01 | FACILITY ID | OTHER | 001018855 | 05 | TX | MEDICAID |