Provider Demographics
NPI:1386043610
Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Other - Org Name:BENBROOK NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-328-6401
Mailing Address - Street 1:1000 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3474
Mailing Address - Country:US
Mailing Address - Phone:817-249-0020
Mailing Address - Fax:817-249-6514
Practice Address - Street 1:1000 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-3474
Practice Address - Country:US
Practice Address - Phone:817-249-0020
Practice Address - Fax:817-249-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004606Medicaid
TX675906Medicare Oscar/Certification