Healthcare Provider Details

I. General information

NPI: 1649824343
Provider Name (Legal Business Name): EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8703 DAVIS BLVD
KELLER TX
76248
US

IV. Provider business mailing address

8703 DAVIS BLVD
KELLER TX
76248-0309
US

V. Phone/Fax

Practice location:
  • Phone: 817-577-9999
  • Fax: 817-849-8388
Mailing address:
  • Phone: 817-577-9999
  • Fax: 817-849-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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