Healthcare Provider Details

I. General information

NPI: 1407892698
Provider Name (Legal Business Name): JACKSON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E ROGERS
GANADO TX
77962-1204
US

IV. Provider business mailing address

107 E ROGERS
GANADO TX
77962-1204
US

V. Phone/Fax

Practice location:
  • Phone: 361-771-3317
  • Fax:
Mailing address:
  • Phone: 361-771-3317
  • 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: MRS. MARCELLA V HENKE
Title or Position: CEO
Credential:
Phone: 361-782-5241