Provider Demographics
NPI:1669021721
Name:STEPHENS MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STEPHENS MEMORIAL HOSPITAL DISTRICT
Other - Org Name:MABANK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-759-6153
Mailing Address - Street 1:18957 US HIGHWAY 175 W
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-1320
Mailing Address - Country:US
Mailing Address - Phone:903-887-2436
Mailing Address - Fax:
Practice Address - Street 1:18957 US HIGHWAY 175 W
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-1320
Practice Address - Country:US
Practice Address - Phone:903-887-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility