Provider Demographics
NPI:1407252448
Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Other - Org Name:PECAN VALLEY HEALTHCARE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-597-2901
Mailing Address - Street 1:1405 W STOREY ST
Mailing Address - Street 2:
Mailing Address - City:SAN SABA
Mailing Address - State:TX
Mailing Address - Zip Code:76877-6422
Mailing Address - Country:US
Mailing Address - Phone:325-372-5112
Mailing Address - Fax:325-372-5114
Practice Address - Street 1:1405 W STOREY ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-6422
Practice Address - Country:US
Practice Address - Phone:325-372-5112
Practice Address - Fax:325-372-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004476Medicaid
TX675715Medicare Oscar/Certification