Provider Demographics
NPI:1518988690
Name:LIVING HOPE NEW BOSTON LLC
Entity Type:Organization
Organization Name:LIVING HOPE NEW BOSTON LLC
Other - Org Name:LIVING HOPE NEW BOSTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KIMBRO
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-791-8388
Mailing Address - Street 1:1111 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5229
Mailing Address - Country:US
Mailing Address - Phone:903-791-8388
Mailing Address - Fax:903-791-8385
Practice Address - Street 1:1111 HAZEL ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5229
Practice Address - Country:US
Practice Address - Phone:903-791-8388
Practice Address - Fax:903-791-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008219282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX670001Medicare Oscar/Certification