Provider Demographics
NPI:1861497539
Name:MITCHELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MITCHELL COUNTY HOSPITAL DISTRICT
Other - Org Name:HEART OF WEST TEXAS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GALYEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-728-2657
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-0454
Mailing Address - Country:US
Mailing Address - Phone:325-728-2657
Mailing Address - Fax:325-728-3527
Practice Address - Street 1:997 W I 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512
Practice Address - Country:US
Practice Address - Phone:325-728-2657
Practice Address - Fax:325-728-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001692251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001692OtherLICENSE NUMBER
677000Medicare ID - Type Unspecified