1730205634 NPI number — COMMUNITY HEALTH DEVELOPMENT, INC

Table of content: (NPI 1730205634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730205634 NPI number — COMMUNITY HEALTH DEVELOPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH DEVELOPMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROLLING HILLS HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730205634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 EVANS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UVALDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78801-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-278-5604
Provider Business Mailing Address Fax Number:
830-278-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 OAK HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAKEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78873-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-232-6985
Provider Business Practice Location Address Fax Number:
830-232-6961
Provider Enumeration Date:
03/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASTANON
Authorized Official First Name:
MAYELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
830-278-5604

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  Z00FM205 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00FM20 . This is a "MEDICARE TRAILBLAZER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111438105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".