Provider Demographics
NPI:1467878629
Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Other - Org Name:THE WESLEYAN SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-868-2700
Mailing Address - Street 1:4011 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2491
Mailing Address - Country:US
Mailing Address - Phone:512-868-2700
Mailing Address - Fax:
Practice Address - Street 1:4011 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2491
Practice Address - Country:US
Practice Address - Phone:512-868-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2020-03-04
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
TX001025768Medicaid
TX001025768Medicaid