Healthcare Provider Details

I. General information

NPI: 1891783429
Provider Name (Legal Business Name): ELECTRA HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S BAILEY ST
ELECTRA TX
76360-2828
US

IV. Provider business mailing address

511 S BAILEY ST P.O. BOX 1226
ELECTRA TX
76360-2828
US

V. Phone/Fax

Practice location:
  • Phone: 940-495-2184
  • Fax: 940-495-3171
Mailing address:
  • Phone: 940-495-2184
  • Fax: 940-495-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110882
License Number StateTX

VIII. Authorized Official

Name: MRS. SANDRA J GIVENS
Title or Position: ADMINISTRATOR
Credential:
Phone: 940-495-2184