Provider Demographics
NPI:1306832092
Name:MITCHELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MITCHELL COUNTY HOSPITAL DISTRICT
Other - Org Name:MITCHELL COUNTY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-728-3431
Mailing Address - Street 1:971 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-2685
Mailing Address - Country:US
Mailing Address - Phone:325-728-5247
Mailing Address - Fax:325-728-5006
Practice Address - Street 1:971 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-2685
Practice Address - Country:US
Practice Address - Phone:325-728-5247
Practice Address - Fax:325-728-5006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHELL COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000422101Medicaid