Provider Demographics
NPI:1629021803
Name:COUNTY OF THROCKMORTON
Entity Type:Organization
Organization Name:COUNTY OF THROCKMORTON
Other - Org Name:GARDEN TERRACE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-849-2141
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-0729
Mailing Address - Country:US
Mailing Address - Phone:940-849-2141
Mailing Address - Fax:
Practice Address - Street 1:1224 CORVADURA ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4355
Practice Address - Country:US
Practice Address - Phone:940-549-4646
Practice Address - Fax:940-549-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-03-10
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
TX001026248Medicaid
TX004896OtherFACILITY ID NO.
TX001026248Medicaid