Provider Demographics
NPI:1760418651
Name:GRAHAM HOSPITAL DISTRICT DBA GRAHAM REGIONAL HOSPICE
Entity Type:Organization
Organization Name:GRAHAM HOSPITAL DISTRICT DBA GRAHAM REGIONAL HOSPICE
Other - Org Name:GRAHAM REGIONAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-549-9704
Mailing Address - Street 1:523 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3037
Mailing Address - Country:US
Mailing Address - Phone:940-549-9704
Mailing Address - Fax:940-549-3978
Practice Address - Street 1:523 ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3037
Practice Address - Country:US
Practice Address - Phone:940-549-9704
Practice Address - Fax:940-549-3978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAHAM HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016109251G00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1001013Medicaid