Provider Demographics
NPI:1578732939
Name:CLARENDON SKILLED CARE LTD
Entity Type:Organization
Organization Name:CLARENDON SKILLED CARE LTD
Other - Org Name:COMMUNITY CARE CENTER OF CLARENDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FREEBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-220-6440
Mailing Address - Street 1:1714 TEASLEY LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7795
Mailing Address - Country:US
Mailing Address - Phone:940-220-6440
Mailing Address - Fax:940-220-6443
Practice Address - Street 1:TEN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226-0300
Practice Address - Country:US
Practice Address - Phone:806-874-5221
Practice Address - Fax:806-874-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000491801Medicaid
TX000491801Medicaid