Healthcare Provider Details

I. General information

NPI: 1003568171
Provider Name (Legal Business Name): LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 VISTA RD
PASADENA TX
77504-2112
US

IV. Provider business mailing address

4006 VISTA RD
PASADENA TX
77504-2112
US

V. Phone/Fax

Practice location:
  • Phone: 713-943-1592
  • Fax: 713-943-2770
Mailing address:
  • Phone: 713-943-1592
  • Fax: 713-943-2770

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