Organization
JACK COUNTY HOSPITAL DISTRICT
Active
Other names
FAITH COMMUNITY HOSPITAL AMBULANCE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY T GENTILE (AUTHORIZED AGENT)
(860) 257-7080
Entity
Organization
Contact information
Practice address
717 MAGNOLIA ST, JACKSBORO, TX 76458-1111
(940) 567-6633
(940) 567-3975
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(860) 257-7080
(860) 563-3403
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
119004
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119874902
—
TX
01
—
P00981602
RAILROAD
TX
Enumeration date
10/10/2006
Last updated
12/22/2011
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