=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417902016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KING'S MANOR METHODIST RETIREMENT SYSTEM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 RANGER ST
-----------------------------------------------------
City | HEREFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79045-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-363-6085
-----------------------------------------------------
Fax | 806-363-6038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1999
-----------------------------------------------------
City | HEREFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79045-1999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-364-0661
-----------------------------------------------------
Fax | 806-364-0675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOSPICE ADMINISTRATOR
-----------------------------------------------------
Name | CHRISTINE MARIE BATENHORST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-363-6085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315D00000X
-----------------------------------------------------
Taxonomy Name | Inpatient Hospice
-----------------------------------------------------
License Number | 008786
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 008786
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------