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General NPI Number Information
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NPI Number | 1609997279
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Entity Type | Organization
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Legal Business Name | FANNIN COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 2320 LAKE SHORE DR
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City | WACO
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State | TX
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Zip | 76708-1276
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Country | US
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Telephone | 254-752-1075
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 LAKE SHORE DR
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City | WACO
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State | TX
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Zip | 76708-1276
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Country | US
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Telephone | 254-752-1075
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Fax |
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | CLARK SANDERSON
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Credential |
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Telephone | 817-372-7224
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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 | 118078
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License Number State | TX
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