Basic Information
| Provider Information | |||||||||
| NPI: | 1639314982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST WHARTON COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRUCARE LIVING CENTERS-COLUMBUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 SANDY CORNER RD | ||||||||
| Address2: | |||||||||
| City: | EL CAMPO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774379535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795436251 | ||||||||
| FaxNumber: | 4794101596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1511 MONTEZUMA STREET | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789342122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794101740 | ||||||||
| FaxNumber: | 4794101596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2008 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | SOECHTING | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 9795436251 | ||||||||
| 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 | 103831 | 01 | TX | FACILITY ID | OTHER |