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General NPI Number Information
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NPI Number | 1326141557
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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 | 09/06/2006
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 4150 COLLEGE ST
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City | BEAUMONT
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State | TX
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Zip | 77707-3902
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Country | US
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Telephone | 409-842-2244
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Fax | 409-842-3399
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Provider Business Mailing Address
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Address Line | 13415 MEDICAL COMPLEX DR SUITE 101
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City | TOMBALL
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State | TX
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Zip | 77375-3343
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Country | US
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Telephone | 832-843-5038
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Fax | 832-843-5050
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Authorized Official
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Title or Position | VP FINANCE
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Name | CHARLES A. DAVIS
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Credential |
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Telephone | 832-843-5038
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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 | 141498
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License Number State | TX
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