- Enrollment id
- O20230920001593
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1235913575
- Multiple npi flag
- N
- Ccn
- 673107
- Associate id
- 3173977477
- Organization name
- PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
- Doing business as name
- PECOS COUNTY MEMORIAL HOSPITAL HOME HEALTH & HOSPICE
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL DISTRICT
- Proprietary nonprofit
- N
- Address line 1
- 387 W IH 10
- City
- FORT STOCKTON
- State
- TX
- Zip code
- 797352708
- Practice location type
- HHA BRANCH