Provider Demographics
NPI:1801803267
Name:COUNTY OF CLAY
Entity type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:940-538-5621
Mailing Address - Street 1:310 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3346
Mailing Address - Country:US
Mailing Address - Phone:940-538-5621
Mailing Address - Fax:940-235-1215
Practice Address - Street 1:305 S ARCHER ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3301
Practice Address - Country:US
Practice Address - Phone:940-235-1274
Practice Address - Fax:940-235-1280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002151251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK06772775Medicaid
TX677277Medicare Oscar/Certification