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General NPI Number Information
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NPI Number | 1558491506
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Entity Type | Organization
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Legal Business Name | STRATFORD HOSPITAL DISTRICT DBA COLDWATER MANOR
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 1111 BEAVER RD.
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City | STRATFORD
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State | TX
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Zip | 79084-1189
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Country | US
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Telephone | 806-396-5568
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Fax | 806-396-5930
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Provider Business Mailing Address
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Address Line | PO BOX 1189 1111 BEAVER RD.
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City | STRATFORD
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State | TX
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Zip | 79084-1189
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Country | US
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Telephone | 806-396-5568
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Fax | 806-396-5930
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK NELSON MOORE
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Credential | LNHFA
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Telephone | 806-396-5568
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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 | 005110
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License Number State | TX
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