Hackberry Creek Care Center, Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

102868 Issued in TX

Legal business name

HACKBERRY CREEK CARE CENTER, INC

Practice address

805 Harrison Ave
Matador, TX 79244-2000

Phone

(806) 347-2942

Fax

(806) 347-2410

NPI assigned

Nov 30, 2006

Last updated

Dec 2, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Seab Washington

Title

President, Board of Hackberry Creek

Phone

(806) 347-2636

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1104994144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 HARRISON AVE",
            "address_2": "P. O. BOX 651",
            "city": "MATADOR",
            "state": "TX",
            "postal_code": "792442000",
            "telephone_number": "806-347-2942",
            "fax_number": "806-347-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 HARRISON AVE",
            "city": "MATADOR",
            "state": "TX",
            "postal_code": "792442000",
            "telephone_number": "806-347-2942",
            "fax_number": "806-347-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKBERRY CREEK CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "SEAB",
        "authorized_official_title_or_position": "PRESIDENT, BOARD OF HACKBERRY CREEK",
        "authorized_official_telephone_number": "806-347-2636",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "102868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS FACILITY ID NUMBER",
            "identifier": "102868",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001014974",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Childress County Hospital District (Matador Health and Rehabilitation Center)
• Aria Faith Cole, OTR
• Linda Graves, OTA
• Ashlee Green
• Sarah Anne Irick, MSN,APRN,FNP-C
• Methodist Hospital Plainview Texas (Motley County Clinic)
• Motley County Hospital District (Motley County Ambulance Service)
• Motley County Isd
• Melinda Lu Osburn

• Nursing Facility/Intermediate Care Facility in Matador, TX
• Providers in Matador, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.