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General NPI Number Information
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NPI Number | 1114985900
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Entity Type | Organization
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Legal Business Name | LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1123 N. BOLTON ST.
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City | JACKSONVILLE
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State | TX
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Zip | 75766-4003
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Country | US
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Telephone | 903-586-9031
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Fax | 903-586-2160
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLAZA SUITE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4831
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Country | US
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Telephone | 817-348-8959
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Fax | 817-348-0466
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES BRUCE STRATTON
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Credential |
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Telephone | 936-336-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 111733
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License Number State | TX
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