Provider Demographics
NPI:1164021689
Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Other - Org Name:RENAISSANCE REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-569-7370
Mailing Address - Street 1:6937 WARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7454
Mailing Address - Country:US
Mailing Address - Phone:410-552-4800
Mailing Address - Fax:410-552-4837
Practice Address - Street 1:220 DAVENPORT
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651-3592
Practice Address - Country:US
Practice Address - Phone:972-483-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001031475Medicaid