Provider Demographics
NPI:1205841160
Name:DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT
Other - Org Name:COON MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNIEDERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-244-9268
Mailing Address - Street 1:210 E TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-4322
Mailing Address - Country:US
Mailing Address - Phone:806-244-8555
Mailing Address - Fax:806-244-1018
Practice Address - Street 1:210 E TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022
Practice Address - Country:US
Practice Address - Phone:806-244-8555
Practice Address - Fax:806-244-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114747313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000407904Medicaid
TX114747OtherSTATE LICENSE