Provider Demographics
NPI:1679735781
Name:CLEBURNE HEALTH CARE LLC
Entity type:Organization
Organization Name:CLEBURNE HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-645-1879
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:1108 W KILPATRICK ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-7477
Practice Address - Country:US
Practice Address - Phone:817-645-3931
Practice Address - Fax:817-645-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016190Medicaid
455665Medicare Oscar/Certification