NPIMap

Organization Active NPI

Parker County Hospital District

Doing business as Matlock Place Health & Rehabilitation Center

  • Skilled Nursing Facility
  • Arlington, TX
National Provider Identifier
1366975856
Registry record updated Mar 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PARKER COUNTY HOSPITAL DISTRICT
Doing business as
Matlock Place Health & Rehabilitation Center
Practice address
7100 Matlock Rd
Arlington, TX 76002-3402
Phone
(817) 466-2511
NPI assigned
Apr 11, 2017
Last updated
Mar 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2019

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

Authorized official

Name
Randy Bacus
Title
Ceo
Phone
(817) 341-2520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X TX Primary

Addresses

Primary practice location

7100 Matlock Rd
Arlington, TX 76002-3402

Mailing address

1130 Pecan Dr
Weatherford, TX 76086-5774

Other names 1

  • Matlock Place Health & Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190418001223 TX Part A Provider - Skilled Nursing Facility 0840269163 Practice locations: Arlington, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366975856. Details of each certification follow.

Skilled nursing facility certification: CCN 676141

Legal name
PARKER COUNTY HOSPITAL DISTRICT
Doing business as
MATLOCK PLACE HEALTH & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 20, 2007
Last certification
May 20, 2025
Beds
148
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Gemini Healthcare LLC
Most recent change of ownership
Apr 1, 2019
Organization structure
GovernmentNon-profit
Enrollment address
7100 Matlock Rd
Arlington, TX 76002-3402
Nursing home name
MATLOCK PLACE HEALTH & REHABILITATION CENTER

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Matlock Place Health & Rehabilitation CenterCCN 676141 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 20, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
148112.2 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
4Fines totaling $51,496

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Campbell Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1130 Pecan Dr
Weatherford, TX 76086
Phone (817) 341-2520

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Parker County Hospital District Organization, Weatherford, TX 5% Or Greater Direct Ownership Interest Apr 1, 2014 100%
Randy B Bacus Individual Corporate OfficerCeo Apr 1, 2019
Ticknor Enterprises Arlington LLC Organization, Arlington, TX LLC Operational/Managerial Control Jan 1, 2023 100%
Gregory Ticknor Individual Operational/Managerial ControlManager Jan 1, 2023 100%
Dominicia Morgan Individual W-2 Managing EmployeeAdministrator Apr 1, 2019

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hilltop Park Rehabilitation and Healthcare CenterWeatherford, TX, CCN 675988 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 15, 2015
Willow Park Rehabilitation and Healthcare CenterWillow Park, TX, CCN 676365 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
College Park Rehabilitation and Care CenterWeatherford, TX, CCN 676212 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 15, 2025
Springtown Park Rehabilitation and Care CenterSpringtown, TX, CCN 676499 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2024
Campbell ClinicWeatherford, TX, CCN 673902 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 4, 1994

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553990400000",
    "number": "1366975856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 PECAN DR",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760865774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 MATLOCK RD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760023402",
            "telephone_number": "817-466-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKER COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2019-03-31",
        "status": "A",
        "authorized_official_last_name": "BACUS",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-341-2520"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Matlock Place Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.