Provider Demographics
NPI:1972693406
Name:RUNNINGWATER DRAW CARE CENTER, INC.
Entity type:Organization
Organization Name:RUNNINGWATER DRAW CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-285-2677
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-0409
Mailing Address - Country:US
Mailing Address - Phone:806-285-2677
Mailing Address - Fax:806-285-2176
Practice Address - Street 1:800 W 13TH ST
Practice Address - Street 2:
Practice Address - City:OLTON
Practice Address - State:TX
Practice Address - Zip Code:79064
Practice Address - Country:US
Practice Address - Phone:806-285-2677
Practice Address - Fax:806-285-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116634313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675117Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER