MEDICARE: LIBERTY COUNTY HOSPITAL DISTRICT NO.1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942623459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY COUNTY HOSPITAL DISTRICT NO.1

Provider Business Mailing Address
First Line	:	8825 LAMPLIGHTER LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7238
Country	:	US
Telephone Number	:	409-727-1651
Fax Number	:

Provider Business Practice Location Address
First Line	:	8825 LAMPLIGHTER LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7238
Country	:	US
Telephone Number	:	409-727-1651
Fax Number	:	469-916-6105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	C. BRUCE STRATTON
Credential	:
Telephone Number	:	469-916-6100

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	05/12/2026

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