Healthcare Provider Details

I. General information

NPI: 1891941936
Provider Name (Legal Business Name): CHILDRESS LIVING CENTER, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 AVENUE G NW
CHILDRESS TX
79201-3304
US

IV. Provider business mailing address

1610 AVENUE G NW
CHILDRESS TX
79201-3304
US

V. Phone/Fax

Practice location:
  • Phone: 940-937-3675
  • Fax:
Mailing address:
  • Phone: 940-937-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number125073
License Number StateTX

VIII. Authorized Official

Name: BURL STRICKER
Title or Position: PRESIDENT
Credential:
Phone: 580-726-3381