Healthcare Provider Details

I. General information

NPI: 1962496836
Provider Name (Legal Business Name): LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 FM 1277
SAN AUGUSTINE TX
75972-1635
US

IV. Provider business mailing address

1500 WATERS RIDGE DR SUITE 200
LEWISVILLE TX
75057-6011
US

V. Phone/Fax

Practice location:
  • Phone: 936-275-3412
  • Fax: 936-275-5394
Mailing address:
  • Phone: 972-899-4152
  • Fax: 469-312-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116419
License Number StateTX

VIII. Authorized Official

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