Healthcare Provider Details

I. General information

NPI: 1447200118
Provider Name (Legal Business Name): LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N HERNDON AVE
KIRBYVILLE TX
75956-1518
US

IV. Provider business mailing address

5560 TENNYSON PARKWAY SUITE 210
PLANO TX
75024
US

V. Phone/Fax

Practice location:
  • Phone: 409-423-6111
  • Fax: 409-423-5807
Mailing address:
  • Phone: 469-916-6100
  • Fax: 469-916-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105977
License Number StateTX

VIII. Authorized Official

Name: CHARLES BRUCE STRATTON
Title or Position: PRESIDENT
Credential:
Phone: 936-336-7400