Provider Demographics
NPI:1740611805
Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:GOODALL-WITCHER HOSPITAL AUTHORITY
Other - Org Name:SUNSET HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-675-7995
Mailing Address - Street 1:1800 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1880
Mailing Address - Country:US
Mailing Address - Phone:254-675-8637
Mailing Address - Fax:254-675-3248
Practice Address - Street 1:1800 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1880
Practice Address - Country:US
Practice Address - Phone:254-675-8637
Practice Address - Fax:254-675-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025615Medicaid
TX004059OtherMEDICAID VENDOR ID
TX675826Medicare Oscar/Certification