Provider Demographics
NPI:1043623200
Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Other - Org Name:MATLOCK PLACE HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-631-5342
Mailing Address - Street 1:304 S DAUGHERTY AVE
Mailing Address - Street 2:P.O. BOX 897
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2609
Mailing Address - Country:US
Mailing Address - Phone:254-631-5342
Mailing Address - Fax:254-629-8929
Practice Address - Street 1:7100 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3402
Practice Address - Country:US
Practice Address - Phone:817-466-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014955314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-6141OtherMEDICARE
TX5504Medicaid