Provider Demographics
NPI:1497813885
Name:RUNNINGWATER DRAW CARE CENTER
Entity Type:Organization
Organization Name:RUNNINGWATER DRAW CARE CENTER
Other - Org Name:SANDHILLS VILLAGE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROLINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-285-3356
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-0767
Mailing Address - Country:US
Mailing Address - Phone:806-285-3356
Mailing Address - Fax:806-285-2506
Practice Address - Street 1:1200 AVE I
Practice Address - Street 2:
Practice Address - City:OLTON
Practice Address - State:TX
Practice Address - Zip Code:79064-0767
Practice Address - Country:US
Practice Address - Phone:806-285-3356
Practice Address - Fax:806-285-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11097310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001381Medicaid