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General NPI Number Information
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NPI Number | 1174511745
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Entity Type | Organization
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Legal Business Name | CHILDRESS HEALTHCARE
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 7TH ST NW
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City | CHILDRESS
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State | TX
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Zip | 79201-2627
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Country | US
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Telephone | 940-937-8668
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Fax | 940-937-8772
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Provider Business Mailing Address
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Address Line | 1200 7TH ST NW
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City | CHILDRESS
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State | TX
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Zip | 79201-2627
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Country | US
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Telephone | 940-937-8668
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Fax | 940-937-8772
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Authorized Official
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Title or Position | MEDICARE MANAGER
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Name | MRS. DAWNA LYNN MCMINN
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Credential | RN
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Telephone | 940-937-8668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 110871
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License Number State | TX
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