Provider Demographics
NPI:1891803706
Name:FISHER COUNTY HEALTHCARE DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:FISHER COUNTY HEALTHCARE DEVELOPMENT CORPORATION
Other - Org Name:FISHER COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:325-735-2687
Mailing Address - Street 1:210 W SAMMY BAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:ROTAN
Mailing Address - State:TX
Mailing Address - Zip Code:79546-4409
Mailing Address - Country:US
Mailing Address - Phone:325-735-2687
Mailing Address - Fax:325-735-3718
Practice Address - Street 1:210 W SAMMY BAUGH AVE
Practice Address - Street 2:
Practice Address - City:ROTAN
Practice Address - State:TX
Practice Address - Zip Code:79546-4409
Practice Address - Country:US
Practice Address - Phone:325-735-2687
Practice Address - Fax:325-735-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009805251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009805OtherHOME HEALTH STATE LICENSE
TX009805OtherHOME HEALTH STATE LICENSE