Healthcare Provider Details

I. General information

NPI: 1124061304
Provider Name (Legal Business Name): LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MOODY ST.
FAIRFIELD TX
75840-3036
US

IV. Provider business mailing address

4150 INTERNATIONAL PLAZA SUITE 600
FORT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 903-389-1236
  • Fax: 903-389-1241
Mailing address:
  • Phone: 817-348-8959
  • Fax: 817-348-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number102704
License Number StateTX

VIII. Authorized Official

Name: MR. CHARLES BRUCE STRATTON
Title or Position: PRESIDENT
Credential:
Phone: 936-336-7422