Healthcare Provider Details

I. General information

NPI: 1528458924
Provider Name (Legal Business Name): SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BLUE BELL RD
BRENHAM TX
77833-2407
US

IV. Provider business mailing address

401 E BLUE BELL RD
BRENHAM TX
77833-2407
US

V. Phone/Fax

Practice location:
  • Phone: 979-836-6611
  • Fax: 979-836-2256
Mailing address:
  • Phone: 979-836-6611
  • Fax: 979-836-2256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number136823
License Number StateTX

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGER
Credential:
Phone: 337-439-6600