Jack County Hospital District

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JACK COUNTY HOSPITAL DISTRICT

Practice address

501 N Main St
Collinsville, TX 76233-5106

Phone

(903) 429-6426

Fax

(903) 429-6240

NPI assigned

Oct 6, 2014

Organization subpart

No

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

Authorized official

Name

Dawn Jones

Title

Fiscal Services Director

Phone

(940) 216-2262

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Homestead Nursing and Rehabilitation of Collinsville Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Jack County Hospital District

  • Ambulatory Surgical Clinic/Center
  • Jacksboro, TX
  • NPI 1154419612

  Member Of

  NPD member

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1205239266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 CHISHOLM TRL",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764581403",
            "telephone_number": "940-567-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N MAIN ST",
            "city": "COLLINSVILLE",
            "state": "TX",
            "postal_code": "762335106",
            "telephone_number": "903-429-6426",
            "fax_number": "903-429-6240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "306 W 7th St",
            "address_purpose": "LOCATION",
            "city": "Ft Worth",
            "state": "TX",
            "postal_code": "761024900",
            "country_code": "US",
            "telephone_number": "817-339-6177",
            "fax_number": "817-339-6178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "FISCAL SERVICES DIRECTOR",
        "authorized_official_telephone_number": "940-216-2262"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67-5206",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homestead Nursing and Rehabilitation of Collinsville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Homestead Nursing and Rehabilitation of Collinsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Collinsville Long Term Care, LLC
• Amy Sue Haverkamp, OTA
• Julie Stewart
• Cameron Kenney, PTA
• Karan Marie Kershner, RD,LD
• Jessica Elaine Lierly
• Pyramid Healthcare Corp.

• All providers in Collinsville, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.