Healthcare Provider Details

I. General information

NPI: 1679735781
Provider Name (Legal Business Name): CLEBURNE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W KILPATRICK ST
CLEBURNE TX
76031-7477
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-3931
  • Fax: 817-645-1879
Mailing address:
  • Phone: 410-773-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LAMON FURR
Title or Position: PRESIDENT
Credential:
Phone: 817-645-1879