Provider Demographics
NPI:1518070309
Name:TYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:TYLER COUNTY HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CITRANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:409-283-6414
Mailing Address - Street 1:211 KELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979
Mailing Address - Country:US
Mailing Address - Phone:409-283-6414
Mailing Address - Fax:409-283-7126
Practice Address - Street 1:211 KELLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4713
Practice Address - Country:US
Practice Address - Phone:409-283-6414
Practice Address - Fax:409-283-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002223251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677428Medicare ID - Type Unspecified