Provider Demographics
NPI:1558596338
Name:THROCKMORTON COUNTY
Entity Type:Organization
Organization Name:THROCKMORTON COUNTY
Other - Org Name:THROCKMORTON COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-849-3081
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-0700
Mailing Address - Country:US
Mailing Address - Phone:940-849-3081
Mailing Address - Fax:940-849-9601
Practice Address - Street 1:1000 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-4900
Practice Address - Country:US
Practice Address - Phone:940-849-2861
Practice Address - Fax:940-849-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001017105Medicaid
TX004246OtherFACILITY ID
TX001017105Medicaid