Healthcare Provider Details

I. General information

NPI: 1871981019
Provider Name (Legal Business Name): NACOGDOCHES COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 RUTHLYNN DR
LONGVIEW TX
75605-5634
US

IV. Provider business mailing address

1204 N MOUND ST
NACOGDOCHES TX
75961-4027
US

V. Phone/Fax

Practice location:
  • Phone: 903-753-8611
  • Fax: 903-758-4026
Mailing address:
  • Phone: 936-568-8523
  • Fax: 936-568-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number136092
License Number StateTX

VIII. Authorized Official

Name: RONALD R PAYNE
Title or Position: MANAGER
Credential:
Phone: 469-916-6100