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Organization
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Active
Organization
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Active
Other names
Copperas Hollow Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID K BYROM (CEO)
(254) 248-6204
Entity
Organization
Contact information
Practice address
345 COUNTRY CLUB DR, CALDWELL, TX 77836-2328
(979) 567-4300
(979) 567-4315
Mailing address
345 COUNTRY CLUB DR, CALDWELL, TX 77836-2328
(979) 567-4300
(979) 567-4315
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001025580
—
TX
01
—
005561
MEDICAID VENDOR ID
TX
05
—
103889
—
TX
Enumeration date
11/22/2013
Last updated
02/18/2014
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