Provider Demographics
NPI:1225164676
Name:CROCKETT HEALTH CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CROCKETT HEALTH CARE ASSOCIATES, INC.
Other - Org Name:HOUSTON COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-544-7884
Mailing Address - Street 1:100 NE LOOP 304
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-5344
Mailing Address - Country:US
Mailing Address - Phone:936-544-7884
Mailing Address - Fax:936-544-4098
Practice Address - Street 1:100 NE LOOP 304
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-5344
Practice Address - Country:US
Practice Address - Phone:936-544-7884
Practice Address - Fax:936-544-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117894313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4227Medicaid
TX4227Medicaid