Provider Demographics
NPI:1457354292
Name:CONIFER CARE,INC.
Entity Type:Organization
Organization Name:CONIFER CARE,INC.
Other - Org Name:THERON GRAINGER REHAB & CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JEWEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-4124
Mailing Address - Street 1:RR 2
Mailing Address - Street 2:
Mailing Address - City:HUGHES SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75656-9812
Mailing Address - Country:US
Mailing Address - Phone:806-771-4124
Mailing Address - Fax:
Practice Address - Street 1:RR 2
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656-9812
Practice Address - Country:US
Practice Address - Phone:806-771-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675137Medicare ID - Type UnspecifiedMCR PROVIDER