Provider Demographics
NPI:1891941936
Name:CHILDRESS LIVING CENTER, INC,
Entity Type:Organization
Organization Name:CHILDRESS LIVING CENTER, INC,
Other - Org Name:THE LIVING CENTER OF CHILDRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BURL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-726-3381
Mailing Address - Street 1:1610 AVENUE G NW
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-3304
Mailing Address - Country:US
Mailing Address - Phone:940-937-3675
Mailing Address - Fax:
Practice Address - Street 1:1610 AVENUE G NW
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-3304
Practice Address - Country:US
Practice Address - Phone:940-937-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125073314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675331Medicare Oscar/Certification