Provider Demographics
NPI:1801221338
Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Other - Org Name:CORONADO HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-567-6633
Mailing Address - Street 1:1504 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3916
Mailing Address - Country:US
Mailing Address - Phone:806-665-5746
Mailing Address - Fax:806-665-6220
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:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005049Medicaid