Healthcare Provider Details

I. General information

NPI: 1508854332
Provider Name (Legal Business Name): SWEETWATER HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 JOSEPHINE ST
SWEETWATER TX
79556-3599
US

IV. Provider business mailing address

1600 JOSEPHINE ST
SWEETWATER TX
79556-3599
US

V. Phone/Fax

Practice location:
  • Phone: 325-236-6653
  • Fax: 325-236-6834
Mailing address:
  • Phone: 325-236-6653
  • Fax: 325-236-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110951
License Number StateTX

VIII. Authorized Official

Name: MRS. ALICE BARRERA
Title or Position: DON
Credential: RN
Phone: 325-236-6653