Healthcare Provider Details

I. General information

NPI: 1023038379
Provider Name (Legal Business Name): GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S AVENUE T
CLIFTON TX
76634-1832
US

IV. Provider business mailing address

PO BOX 549
CLIFTON TX
76634-0549
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-8322
  • Fax: 254-675-2246
Mailing address:
  • Phone: 254-675-8322
  • Fax: 254-675-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number005355
License Number StateTX

VIII. Authorized Official

Name: ADAM WILLMANN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 254-675-8322