Provider Demographics
NPI:1215977582
Name:STRATFORD HOSPITAL DISTRICT
Entity type:Organization
Organization Name:STRATFORD HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO OF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-410-7300
Mailing Address - Street 1:5301 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4940
Mailing Address - Country:US
Mailing Address - Phone:806-795-8792
Mailing Address - Fax:806-795-4614
Practice Address - Street 1:5301 UNIVERSITY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413
Practice Address - Country:US
Practice Address - Phone:806-795-8792
Practice Address - Fax:806-795-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140942314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026081Medicaid
TX675346Medicare Oscar/Certification
TX675346Medicare Oscar/Certification