Healthcare Provider Details

I. General information

NPI: 1649268152
Provider Name (Legal Business Name): COUNTY OF THROCKMORTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 N 1ST ST
HASKELL TX
79521-5438
US

IV. Provider business mailing address

802 N MINTER AVE
THROCKMORTON TX
76483-5357
US

V. Phone/Fax

Practice location:
  • Phone: 940-864-8537
  • Fax: 940-864-8040
Mailing address:
  • Phone: 940-849-2141
  • Fax: 940-849-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIRBY GOBER
Title or Position: CEO
Credential:
Phone: 940-849-2141