Healthcare Provider Details

I. General information

NPI: 1063409977
Provider Name (Legal Business Name): COMMUNITY SPECIALTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 GALLAGHER DR
SHERMAN TX
75090-1713
US

IV. Provider business mailing address

PO BOX 8026
WICHITA FALLS TX
76307-8026
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-7000
  • Fax:
Mailing address:
  • Phone: 940-322-3171
  • Fax: 940-761-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number008187
License Number StateTX

VIII. Authorized Official

Name: MR. STEWART POWERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-870-7000