Provider Demographics
NPI:1093232084
Name:WINNIE-STOWELL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WINNIE-STOWELL HOSPITAL DISTRICT
Other - Org Name:CREEKSIDE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-296-1003
Mailing Address - Street 1:914 BRAZOSPORT BLVD N
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77531-3720
Mailing Address - Country:US
Mailing Address - Phone:979-265-4794
Mailing Address - Fax:979-265-4898
Practice Address - Street 1:914 BRAZOSPORT BLVD N
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:TX
Practice Address - Zip Code:77531-3720
Practice Address - Country:US
Practice Address - Phone:979-265-4794
Practice Address - Fax:979-265-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676304251J00000X, 314000000X, 314000000X
TX001028967314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001028967Medicaid
TX4663Medicaid