HACKBERRY CREEK CARE CENTER, INC (NPI# 1104994144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104994144 |
| Entity Type | Organization |
| Organization Name | HACKBERRY CREEK CARE CENTER, INC |
| Practice Address |
805 Harrison Ave Matador TX 79244-2000 |
| Mailing Address |
805 Harrison Ave P. O. Box 651 Matador TX 79244-2000 |
| Practice Telephone | 8063472942 |
| Practice Fax Number | 8063472410 |
| Mailing Telephone | 8063472942 |
| Mailing Fax Number | 8063472410 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-12-02 |
| Authorized Official Name | MR. SEAB WASHINGTON (PRESIDENT, BOARD OF HACKBERRY CREEK) |
| Authorized Official Telephone | 8063472636 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 102868 | TX | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TEXAS FACILITY ID NUMBER | 102868 | 01 |
| TX | 001014974 | 05 |
| Street Address |
805 HARRISON AVE |
| City | MATADOR |
| State | TX |
| Zip Code | 79244-2000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134776073 | Aria Faith Cole | Occupational Therapist | 805 Harrison Ave, Matador, TX 79244-2000 | 2019-08-26 |
| 1548653082 | Childress County Hospital District | Skilled Nursing Facility | 805 Harrison Ave, Matador, TX 79244-2000 | 2015-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235139890 | Gail Raylien Ream | Physician Assistant | 1224 Main Street, Matador, TX 79244 | 2005-07-26 |
| 1396743837 | Regence Health Network Inc | Clinic/Center | 1224 Main St, Matador, TX 79244 | 2005-07-08 |
| 1699080135 | Methodist Hospital Plainview Texas | Clinic/Center | 1224 Main Street, Matador, TX 79244 | 2010-08-09 |
| 1518012293 | Motley County Hospital District | Ambulance | 1224 Main, Matador, TX 79244-0009 | 2007-01-24 |
| 1275866097 | John Andrews Tafel | Physical Medicine & Rehabilitation | 1007 Walton Road, Matador, TX 79244-0357 | 2009-09-11 |
| 1992226963 | Motley County Isd | Local Education Agency (LEA) | 1600 Bundy St, Matador, TX 79244-2039 | 2017-06-29 |
| 1407136591 | Dustin James Rose | Chiropractor | 3529 Heritage Trace Pkwy Suite 155, Fort Worth, TX 79244-4984 | 2011-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992226963 | Motley County Isd | Local Education Agency (LEA) | 1600 Bundy St, Matador, TX 79244-2039 | 2017-06-29 |
| 1275866097 | John Andrews Tafel | Physical Medicine & Rehabilitation | 1007 Walton Road, Matador, TX 79244-0357 | 2009-09-11 |
| 1518012293 | Motley County Hospital District | Ambulance | 1224 Main, Matador, TX 79244-0009 | 2007-01-24 |
| 1235139890 | Gail Raylien Ream | Physician Assistant | 1224 Main Street, Matador, TX 79244 | 2005-07-26 |
| 1396743837 | Regence Health Network Inc | Clinic/Center | 1224 Main St, Matador, TX 79244 | 2005-07-08 |
| 1699080135 | Methodist Hospital Plainview Texas | Clinic/Center | 1224 Main Street, Matador, TX 79244 | 2010-08-09 |
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922660471 | Castro County Hospital District | Nursing Facility/Intermediate Care Facility | 701 Butler Blvd, Dimmitt, TX 79027-2720 | 2019-07-05 |
| 1023674520 | Eunice Nadine Hall | Nursing Facility/Intermediate Care Facility | 110 W. Troupe St, Mabank, TX 75147-8651 | 2019-05-10 |
| 1467945626 | Regency Ihs of Windsor Mission Oaks LLC | Nursing Facility/Intermediate Care Facility | 3030 S Roosevelt Ave, San Antonio, TX 78214-2337 | 2018-06-12 |
| 1508363086 | Solomon Ishaq | Nursing Facility/Intermediate Care Facility | 1818 Arundel Dr, Carrollton, TX 75007-3012 | 2018-04-10 |
| 1740798651 | Mission Valley Nursing and Transitional Care LLC | Nursing Facility/Intermediate Care Facility | 1200 S Bryan Rd, Mission, TX 78572-6840 | 2018-01-12 |
| 1841738580 | Su Casa Adult Foster Home | Nursing Facility/Intermediate Care Facility | 12462 Paseo De Arco Ct, El Paso, TX 79928-5669 | 2017-02-02 |
| 1225402753 | West Wharton County Hospital District | Nursing Facility/Intermediate Care Facility | 248 Wisteria Ln, El Campo, TX 77437-2545 | 2015-11-20 |
| 1447635040 | Sarah Padlan I | Nursing Facility/Intermediate Care Facility | 3808 Veterans Blvd, Studio 6, Del Rio, TX 78840-2859 | 2015-07-23 |
| 1902289358 | Fnu Anushree | Nursing Facility/Intermediate Care Facility | 328 Bedford Rd Apt 247, Bedford, TX 76022-8032 | 2015-07-02 |
| 1699154278 | Royal Manor Care Center, Inc. | Nursing Facility/Intermediate Care Facility | 4545 S Buckner Blvd, Dallas, TX 75227-4207 | 2015-05-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.