Provider Demographics
NPI:1447619663
Name:CLARENDON NH OPERATIONS
Entity type:Organization
Organization Name:CLARENDON NH OPERATIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-637-7561
Mailing Address - Street 1:TEN MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:TX
Mailing Address - Zip Code:79226
Mailing Address - Country:US
Mailing Address - Phone:806-874-5221
Mailing Address - Fax:806-874-5619
Practice Address - Street 1:TEN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226
Practice Address - Country:US
Practice Address - Phone:937-459-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146235314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004918Medicaid
TX676058Medicare Oscar/Certification