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General NPI Number Information
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NPI Number | 1225164676
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Entity Type | Organization
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Legal Business Name | CROCKETT HEALTH CARE ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 100 NE LOOP 304
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City | CROCKETT
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State | TX
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Zip | 75835-5344
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Country | US
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Telephone | 936-544-7884
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Fax | 936-544-4098
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Provider Business Mailing Address
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Address Line | 100 NE LOOP 304
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City | CROCKETT
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State | TX
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Zip | 75835-5344
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Country | US
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Telephone | 936-544-7884
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Fax | 936-544-4098
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Authorized Official
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Title or Position | ADMINISTRATOR, OWNER
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Name | DENNIS BAKER
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Credential |
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Telephone | 936-544-7884
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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 | 117894
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License Number State | TX
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