MEDICARE: MCCASKILL HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	120857	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295934354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCASKILL HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	1501 7TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3103
Country	:	US
Telephone Number	:	940-322-0741
Fax Number	:	940-322-1845

Provider Business Practice Location Address
First Line	:	1501 7TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3103
Country	:	US
Telephone Number	:	940-322-0741
Fax Number	:	940-322-1845

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. DONALD B MCCASKILL
Credential	:	CNHA
Telephone Number	:	918-534-6121

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	01/07/2008

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