Basic Information
| Provider Information | |||||||||
| NPI: | 1861497539 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MITCHELL COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HEART OF WEST TEXAS HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 454 | ||||||||
| Address2: | |||||||||
| City: | COLORADO CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795120454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257282657 | ||||||||
| FaxNumber: | 3257283527 | ||||||||
| Practice Location | |||||||||
| Address1: | 997 W I 20 | ||||||||
| Address2: | |||||||||
| City: | COLORADO CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257282657 | ||||||||
| FaxNumber: | 3257283527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GALYEAN | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3257282657 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 001692 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 001692 | 01 | TX | LICENSE NUMBER | OTHER |