Provider Demographics
NPI:1063445203
Name:CZECH CATHOLIC HOME FOR THE AGED
Entity Type:Organization
Organization Name:CZECH CATHOLIC HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:SOHRT
Authorized Official - Last Name:MOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF SCIENCE
Authorized Official - Phone:979-648-2628
Mailing Address - Street 1:RR 3 BOX 40
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9601
Mailing Address - Country:US
Mailing Address - Phone:979-648-2628
Mailing Address - Fax:979-648-2884
Practice Address - Street 1:RR 3 BOX 40
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9601
Practice Address - Country:US
Practice Address - Phone:979-648-2628
Practice Address - Fax:979-648-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109078313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility