Provider Demographics
NPI:1306026729
Name:NACOGDOCHES COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NACOGDOCHES COUNTY HOSPITAL DISTRICT
Other - Org Name:HERITAGE HOUSE OF MARSHALL HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-916-6100
Mailing Address - Street 1:1204 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-568-8523
Mailing Address - Fax:936-568-8588
Practice Address - Street 1:5915 ELYSIAN FIELDS ROAD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-2083
Practice Address - Country:US
Practice Address - Phone:903-935-6700
Practice Address - Fax:903-935-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103421Medicaid
TX676187Medicare Oscar/Certification