Healthcare Provider Details

I. General information

NPI: 1467435743
Provider Name (Legal Business Name): SOUTHLAND HEALTH CARE CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MEDFORD DR
LUFKIN TX
75901-5219
US

IV. Provider business mailing address

501 N MEDFORD DR
LUFKIN TX
75901-5219
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-1252
  • Fax: 936-639-1455
Mailing address:
  • Phone: 936-639-1252
  • Fax: 936-639-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number111109
License Number StateTX

VIII. Authorized Official

Name: MR. HULEN SQUYRES
Title or Position: L.L.C.-PARTNER
Credential:
Phone: 936-639-1252