Provider Demographics
NPI:1467435743
Name:SOUTHLAND HEALTH CARE CENTER, LTD.
Entity Type:Organization
Organization Name:SOUTHLAND HEALTH CARE CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.L.C.-PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HULEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUYRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-639-1252
Mailing Address - Street 1:501 N MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5219
Mailing Address - Country:US
Mailing Address - Phone:936-639-1252
Mailing Address - Fax:936-639-1455
Practice Address - Street 1:501 N MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5219
Practice Address - Country:US
Practice Address - Phone:936-639-1252
Practice Address - Fax:936-639-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111109310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness