Provider Demographics
NPI:1497211437
Name:HAMILTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HAMILTON COUNTY HOSPITAL DISTRICT
Other - Org Name:BRODIE RANCH NURSING AND REHABILITATION CENTER
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 1:2101 FRATE BARKER RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3614
Mailing Address - Country:US
Mailing Address - Phone:512-444-5627
Mailing Address - Fax:512-368-2034
Practice Address - Street 1:2101 FRATE BARKER RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3614
Practice Address - Country:US
Practice Address - Phone:512-444-5627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104451Medicaid
TX5586Medicaid
TX001030444Medicaid