Provider Demographics
NPI:1295934354
Name:MCCASKILL HEALTH CARE, LLC
Entity type:Organization
Organization Name:MCCASKILL HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:918-534-6121
Mailing Address - Street 1:1501 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-3103
Mailing Address - Country:US
Mailing Address - Phone:940-322-0741
Mailing Address - Fax:940-322-1845
Practice Address - Street 1:1501 7TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3103
Practice Address - Country:US
Practice Address - Phone:940-322-0741
Practice Address - Fax:940-322-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120857314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004200Medicaid