Provider Demographics
NPI:1033164488
Name:KING'S DAUGHTERS HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:KING'S DAUGHTERS HOSPITAL ASSOCIATION
Other - Org Name:KING'S DAUGHTERS HOSPITAL SKILLED NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-771-8609
Mailing Address - Street 1:1901 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1814
Mailing Address - Country:US
Mailing Address - Phone:254-771-8600
Mailing Address - Fax:254-942-9545
Practice Address - Street 1:1901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-771-8600
Practice Address - Fax:254-942-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000186314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH2624OtherBLUE CROSS
TXHH2624OtherBLUE CROSS