Healthcare Provider Details

I. General information

NPI: 1235121245
Provider Name (Legal Business Name): EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 OLD ANSON RD
ABILENE TX
79603-1834
US

IV. Provider business mailing address

2722 OLD ANSON RD
ABILENE TX
79603-1834
US

V. Phone/Fax

Practice location:
  • Phone: 325-676-1677
  • Fax: 325-676-3941
Mailing address:
  • Phone: 325-676-1677
  • Fax: 325-676-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108191
License Number StateTX

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249