Provider Demographics
NPI:1912943887
Name:NOCONA NURSING HOME INC
Entity Type:Organization
Organization Name:NOCONA NURSING HOME INC
Other - Org Name:NOCONA NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-448-3700
Mailing Address - Street 1:306 CAROLYN RD
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255-3105
Mailing Address - Country:US
Mailing Address - Phone:940-825-3288
Mailing Address - Fax:940-825-6153
Practice Address - Street 1:306 CAROLYN RD
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255-3105
Practice Address - Country:US
Practice Address - Phone:940-825-3288
Practice Address - Fax:940-825-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113126314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000427Medicaid
TX144512402OtherMEDICAID TPI
675554Medicare ID - Type Unspecified