Provider Demographics
NPI:1457468431
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:REGENT CARE CENTER OF WOODWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-248-6245
Mailing Address - Street 1:7801 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3860
Mailing Address - Country:US
Mailing Address - Phone:254-235-7801
Mailing Address - Fax:254-235-5834
Practice Address - Street 1:7801 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3860
Practice Address - Country:US
Practice Address - Phone:254-235-7801
Practice Address - Fax:254-235-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111693314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004089Medicaid
TX675924Medicare Oscar/Certification
TX001004089Medicaid