Basic Information
| Provider Information | |||||||||
| NPI: | 1831593029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHENS MEMORIAL HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | HOMESTEAD NURSING AND REHABILITATION OF BAIRD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173396177 | ||||||||
| FaxNumber: | 8173396178 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BAIRD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795043606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173396177 | ||||||||
| FaxNumber: | 8173396178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2014 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | KEMPTON | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2545592241 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 1831593029 | 05 | TX | MEDICAID |