Provider Demographics
NPI:1518943216
Name:FARWELL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FARWELL HOSPITAL DISTRICT
Other - Org Name:FARWELL CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-292-4859
Mailing Address - Street 1:305 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:TX
Mailing Address - Zip Code:79325-5615
Mailing Address - Country:US
Mailing Address - Phone:806-481-9027
Mailing Address - Fax:806-481-9503
Practice Address - Street 1:305 5TH STREET
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:TX
Practice Address - Zip Code:79325
Practice Address - Country:US
Practice Address - Phone:806-481-9027
Practice Address - Fax:806-481-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111189314000000X
332BN1400X, 332BP3500X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000509302Medicaid
TX675098Medicare ID - Type UnspecifiedPART B
TX000509302Medicaid
SD675098Medicare Oscar/Certification