Healthcare Provider Details

I. General information

NPI: 1033570908
Provider Name (Legal Business Name): EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MEDICAL CENTER DR
ENNIS TX
75119-1587
US

IV. Provider business mailing address

1400 MEDICAL CENTER DR
ENNIS TX
75119-1587
US

V. Phone/Fax

Practice location:
  • Phone: 972-875-4800
  • Fax: 972-875-4815
Mailing address:
  • Phone: 972-875-4800
  • Fax: 972-875-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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