Provider Demographics
NPI:1093131476
Name:NACOGDOCHES COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NACOGDOCHES COUNTY HOSPITAL DISTRICT
Other - Org Name:BONNER STREET PLAZA HEALTHCARE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:365-694-1679
Mailing Address - Street 1:1018 N MOUND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4434
Mailing Address - Country:US
Mailing Address - Phone:936-221-5809
Mailing Address - Fax:936-569-4159
Practice Address - Street 1:810 BELLAIRE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9045
Practice Address - Country:US
Practice Address - Phone:903-589-5300
Practice Address - Fax:903-589-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110205Medicaid
TX5275Medicaid