Provider Demographics
NPI:1407202021
Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Other - Org Name:LEGEND OAKS HEALTHCARE AND REHABILITATION-WAXAHACHIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER OF MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:151 COUNTRY MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7811
Mailing Address - Country:US
Mailing Address - Phone:972-937-1650
Mailing Address - Fax:844-267-1744
Practice Address - Street 1:151 COUNTRY MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7811
Practice Address - Country:US
Practice Address - Phone:972-937-1650
Practice Address - Fax:844-267-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare Oscar/Certification