Basic Information
| Provider Information | |||||||||
| NPI: | 1760470181 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRATFORD HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORONADO HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1189 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790841189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063965568 | ||||||||
| FaxNumber: | 8063962086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1504 W KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | PAMPA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790653916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066655746 | ||||||||
| FaxNumber: | 8066656220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8063965568 | ||||||||
| 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 | 001026067 | 05 | TX | MEDICAID | 005049 | 01 | TX | FACILITY ID NO. | OTHER |