Provider Demographics
NPI:1326113762
Name:PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Other - Org Name:PALESTINE REGIONAL REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:103 POWELL CT
Mailing Address - Street 2:STE. 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5079
Mailing Address - Country:US
Mailing Address - Phone:615-372-8500
Mailing Address - Fax:615-372-8572
Practice Address - Street 1:4000 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8467
Practice Address - Country:US
Practice Address - Phone:903-731-1000
Practice Address - Fax:903-731-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000377283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159165301Medicaid
TX159165301Medicaid