MEDICARE: EASTLAND MEMORIAL HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		TX

General Provider Information

NPI Number	:	1578642252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTLAND MEMORIAL HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1618 KIRBY RD
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-7453
Country	:	US
Telephone Number	:	972-245-1573
Fax Number	:	972-245-6082

Provider Business Practice Location Address
First Line	:	1618 KIRBY RD
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-7453
Country	:	US
Telephone Number	:	972-245-1573
Fax Number	:	972-245-6082

Authorized Official
Title or Position	:	TREASURER
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	12/13/2022

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