Provider Demographics
NPI:1639535131
Name:TYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:THE BRADFORD AT BROOKSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EDD
Authorized Official - Phone:409-283-4600
Mailing Address - Street 1:1100 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4738
Mailing Address - Country:US
Mailing Address - Phone:409-283-6400
Mailing Address - Fax:409-283-5961
Practice Address - Street 1:301 W PARK
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8151
Practice Address - Country:US
Practice Address - Phone:936-328-5021
Practice Address - Fax:936-328-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142698314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility