Provider Demographics
NPI:1831287499
Name:ROLLING PLAINS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ROLLING PLAINS MEMORIAL HOSPITAL
Other - Org Name:ROLLING PLAINS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-235-1701
Mailing Address - Street 1:200 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7120
Mailing Address - Country:US
Mailing Address - Phone:325-235-2030
Mailing Address - Fax:325-235-0613
Practice Address - Street 1:200 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7120
Practice Address - Country:US
Practice Address - Phone:325-235-2030
Practice Address - Fax:325-235-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002146251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095118802Medicaid
TX095118802Medicaid