Healthcare Provider Details

I. General information

NPI: 1871991802
Provider Name (Legal Business Name): SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DALLAS ST
WACO TX
76704-1711
US

IV. Provider business mailing address

1010 DALLAS ST
WACO TX
76704-1711
US

V. Phone/Fax

Practice location:
  • Phone: 254-752-9774
  • Fax: 254-227-6007
Mailing address:
  • Phone: 254-752-9774
  • Fax: 254-227-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140914
License Number StateTX

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGER
Credential:
Phone: 337-439-6600