Provider Demographics
NPI:1639314560
Name:LIBERTY COUNTY HOSPITAL DISTRICT NO.1
Entity Type:Organization
Organization Name:LIBERTY COUNTY HOSPITAL DISTRICT NO.1
Other - Org Name:SOUTHLAND REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-540-1249
Mailing Address - Street 1:501 NORTH MEDFORD DRIVE
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 NORTH MEDFORD DRIVE
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:2008-12-05
Last Update Date:2022-05-30
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
CA675962Medicare Oscar/Certification