Provider Demographics
NPI:1174511745
Name:CHILDRESS HEALTHCARE
Entity Type:Organization
Organization Name:CHILDRESS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-937-8668
Mailing Address - Street 1:1200 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-2627
Mailing Address - Country:US
Mailing Address - Phone:940-937-8668
Mailing Address - Fax:940-937-8772
Practice Address - Street 1:1200 7TH ST NW
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2627
Practice Address - Country:US
Practice Address - Phone:940-937-8668
Practice Address - Fax:940-937-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110871311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home