Healthcare Provider Details

I. General information

NPI: 1780710681
Provider Name (Legal Business Name): GROVETON TEXAS HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 890 HWY 287 N
GROVETON TX
75845-0890
US

IV. Provider business mailing address

PO BOX 890
GROVETON TX
75845-0890
US

V. Phone/Fax

Practice location:
  • Phone: 936-642-1221
  • Fax: 936-642-2727
Mailing address:
  • Phone: 936-642-1221
  • Fax: 936-642-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number117377
License Number StateTX

VIII. Authorized Official

Name: JENNIFER LYNN CLEVELAND
Title or Position: BUSINESS OFFICE MANAGER
Credential: BOM
Phone: 936-642-1221