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General NPI Number Information
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NPI Number | 1043880123
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Entity Type | Organization
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Legal Business Name | LION STAR NACOGDOCHES HOSPITAL, LLC
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 707 WOODS ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4411
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Country | US
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Telephone | 936-568-8488
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Fax |
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Provider Business Mailing Address
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Address Line | 707 WOODS ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4411
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Country | US
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Telephone | 936-568-8488
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | BRANDY BOYD
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Credential | CPA
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Telephone | 936-568-8523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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