Provider Demographics
NPI:1679721344
Name:PARKER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PARKER COUNTY HOSPITAL DISTRICT
Other - Org Name:COLLEGE PARK REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-341-2520
Mailing Address - Street 1:1130 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5774
Mailing Address - Country:US
Mailing Address - Phone:817-341-2520
Mailing Address - Fax:817-458-3150
Practice Address - Street 1:1715 MARTIN DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6738
Practice Address - Country:US
Practice Address - Phone:817-458-3100
Practice Address - Fax:817-458-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2021-12-28
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
TX103708OtherFACILITY ID
676212Medicare Oscar/Certification
676212Medicare Oscar/Certification