Provider Demographics
NPI:1699932889
Name:LABRANJOR HEALTH CARE LLC
Entity type:Organization
Organization Name:LABRANJOR HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BURL
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-704-8630
Mailing Address - Street 1:3003 MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1249
Mailing Address - Country:US
Mailing Address - Phone:940-704-8630
Mailing Address - Fax:940-228-5499
Practice Address - Street 1:15366 OAK STREET
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-0486
Practice Address - Country:US
Practice Address - Phone:830-772-3557
Practice Address - Fax:830-772-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118358314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-5295OtherMEDICARE