Provider Demographics
NPI:1841563038
Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Other - Org Name:SOUTHERN SPECIALTY REHAB & NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-578-5250
Mailing Address - Street 1:4150 INTERNATIONAL PLAZA
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4831
Mailing Address - Country:US
Mailing Address - Phone:817-348-8959
Mailing Address - Fax:817-348-0466
Practice Address - Street 1:4320 WEST 19TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2407
Practice Address - Country:US
Practice Address - Phone:806-795-1774
Practice Address - Fax:806-771-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020268Medicaid
TX004235OtherFACILITY ID
TX676028Medicare Oscar/Certification