Provider Demographics
NPI:1508854332
Name:SWEETWATER HEALTH CARE CENTER
Entity Type:Organization
Organization Name:SWEETWATER HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-236-6653
Mailing Address - Street 1:1600 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-3599
Mailing Address - Country:US
Mailing Address - Phone:325-236-6653
Mailing Address - Fax:325-236-6834
Practice Address - Street 1:1600 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-3599
Practice Address - Country:US
Practice Address - Phone:325-236-6653
Practice Address - Fax:325-236-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5946Medicare ID - Type Unspecified