Provider Demographics
NPI:1407892698
Name:JACKSON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:JACKSON COUNTY HOSPITAL DISTRICT
Other - Org Name:JACKSON NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-782-5241
Mailing Address - Street 1:107 E ROGERS
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962-1204
Mailing Address - Country:US
Mailing Address - Phone:361-771-3317
Mailing Address - Fax:
Practice Address - Street 1:107 E ROGERS
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:TX
Practice Address - Zip Code:77962-1204
Practice Address - Country:US
Practice Address - Phone:361-771-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676076Medicare Oscar/Certification