Healthcare Provider Details

I. General information

NPI: 1669912564
Provider Name (Legal Business Name): NACOGDOCHES COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N MOUND ST
NACOGDOCHES TX
75961-4027
US

IV. Provider business mailing address

1204 N MOUND ST
NACOGDOCHES TX
75961-4027
US

V. Phone/Fax

Practice location:
  • Phone: 936-568-8523
  • Fax:
Mailing address:
  • Phone: 936-568-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARY KENDRICK
Title or Position: CEO
Credential:
Phone: 936-568-8523