Provider Demographics
NPI:1114978780
Name:FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:FANNIN COUNTY HOSPITAL AUTHORITY
Other - Org Name:CANTON HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-583-8585
Mailing Address - Street 1:504 LIPSCOMB ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4028
Mailing Address - Country:US
Mailing Address - Phone:903-583-8585
Mailing Address - Fax:903-640-7601
Practice Address - Street 1:1661 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2619
Practice Address - Country:US
Practice Address - Phone:903-567-4135
Practice Address - Fax:903-567-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004836OtherFACILITY ID NO.
TX004836OtherFACILITY ID NO.
TX45-5987Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX000483606Medicaid