Healthcare Provider Details

I. General information

NPI: 1659535441
Provider Name (Legal Business Name): COUNTY OF THROCKMORTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 1ST ST.
GRAHAM TX
76450-3603
US

IV. Provider business mailing address

4150 INTERNATIONAL PLAZA SUITE 600
FORT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 940-549-8787
  • Fax: 940-521-0355
Mailing address:
  • Phone: 817-348-8959
  • Fax: 817-348-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114203
License Number StateTX

VIII. Authorized Official

Name: MR. KIRBY D GOBER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 940-849-2141