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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