Healthcare Provider Details

I. General information

NPI: 1336190347
Provider Name (Legal Business Name): LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S ROBB ST
TRINITY TX
75862-7602
US

IV. Provider business mailing address

808 S ROBB ST
TRINITY TX
75862-7602
US

V. Phone/Fax

Practice location:
  • Phone: 936-594-7521
  • Fax: 936-594-3430
Mailing address:
  • Phone: 936-336-7400
  • Fax: 936-336-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number005199
License Number StateTX

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: AUTGHORIZED AGENT
Credential:
Phone: 949-540-1249