Provider Demographics
NPI:1104221894
Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Other - Org Name:PALO DURO NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-937-9178
Mailing Address - Street 1:405 S COLLINS STREET
Mailing Address - Street 2:
Mailing Address - City:CLAUDE
Mailing Address - State:TX
Mailing Address - Zip Code:79019
Mailing Address - Country:US
Mailing Address - Phone:806-226-5121
Mailing Address - Fax:806-226-2495
Practice Address - Street 1:405 S COLLINS STREET
Practice Address - Street 2:
Practice Address - City:CLAUDE
Practice Address - State:TX
Practice Address - Zip Code:79019
Practice Address - Country:US
Practice Address - Phone:806-226-5121
Practice Address - Fax:806-226-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004412Medicaid
TX004412Medicaid