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General NPI Number Information
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NPI Number | 1104994144
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Entity Type | Organization
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Legal Business Name | HACKBERRY CREEK CARE CENTER, INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 805 HARRISON AVE
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City | MATADOR
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State | TX
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Zip | 79244-2000
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Country | US
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Telephone | 806-347-2942
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Fax | 806-347-2410
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Provider Business Mailing Address
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Address Line | 805 HARRISON AVE P. O. BOX 651
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City | MATADOR
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State | TX
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Zip | 79244-2000
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Country | US
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Telephone | 806-347-2942
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Fax | 806-347-2410
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Authorized Official
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Title or Position | PRESIDENT, BOARD OF HACKBERRY CREEK
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Name | MR. SEAB WASHINGTON
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Credential |
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Telephone | 806-347-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 102868
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License Number State | TX
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