Healthcare Provider Details

I. General information

NPI: 1619948759
Provider Name (Legal Business Name): COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W OAK AVE
COMANCHE TX
76442-3273
US

IV. Provider business mailing address

108 W OAK AVE
COMANCHE TX
76442-3273
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-2509
  • Fax: 325-356-3716
Mailing address:
  • Phone: 325-356-2509
  • Fax: 325-356-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number007655
License Number StateTX

VIII. Authorized Official

Name: WILLIAM EVAN MOORE
Title or Position: CEO
Credential:
Phone: 254-879-4900