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General NPI Number Information
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NPI Number | 1457859589
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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 | 01/23/2018
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 2212 W REAGAN ST
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City | PALESTINE
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State | TX
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Zip | 75801-2222
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Country | US
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Telephone | 903-727-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 624 FANNIN ST
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City | LIBERTY
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State | TX
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Zip | 77575-4916
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Country | US
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Telephone | 936-336-7400
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Fax |
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | CHARLES BRUCE STRATTON
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Credential |
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Telephone | 936-336-7400
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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 |
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License Number State | TX
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