# JACK COUNTY HOSPITAL DISTRICT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** FAITH COMMUNITY HOSPITAL AMBULANCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336237890
- **Authorized official:** MRS. MARY T GENTILE (AUTHORIZED AGENT)
- **Authorized official phone:** (860) 257-7080

## Contact information

- **Practice address:** 717 MAGNOLIA ST, JACKSBORO, TX 76458-1111
- **Practice address phone:** (940) 567-6633
- **Practice address fax:** (940) 567-3975
- **Mailing address:** PO BOX 290184, WETHERSFIELD, CT 06129-0184
- **Mailing address phone:** (860) 257-7080
- **Mailing address fax:** (860) 563-3403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 119004 | TX | Yes |

## Other

- **Enumeration date:** 10/10/2006
- **Last updated:** 12/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 119874902 | — | TX |
| 01 | — | P00981602 | RAILROAD | TX |