Provider Demographics
NPI:1760470181
Name:STRATFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STRATFORD HOSPITAL DISTRICT
Other - Org Name:CORONADO HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-396-5568
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79084-1189
Mailing Address - Country:US
Mailing Address - Phone:806-396-5568
Mailing Address - Fax:806-396-2086
Practice Address - Street 1:1504 W KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-3916
Practice Address - Country:US
Practice Address - Phone:806-665-5746
Practice Address - Fax:806-665-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2015-03-05
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
TX001026067Medicaid
TX005049OtherFACILITY ID NO.
TX005049OtherFACILITY ID NO.
TX1248470024Medicare NSC