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General NPI Number Information
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NPI Number | 1407892698
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Entity Type | Organization
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Legal Business Name | JACKSON COUNTY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 107 E ROGERS
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City | GANADO
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State | TX
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Zip | 77962-1204
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Country | US
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Telephone | 361-771-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E ROGERS
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City | GANADO
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State | TX
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Zip | 77962-1204
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Country | US
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Telephone | 361-771-3317
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARCELLA V HENKE
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Credential |
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Telephone | 361-782-5241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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