Provider Demographics
NPI:1710306253
Name:BURLESON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:BURLESON COUNTY HOSPITAL DISTRICT
Other - Org Name:ST. JOSEPH MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-567-3244
Mailing Address - Street 1:2333 MANOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-821-7398
Mailing Address - Fax:979-821-7301
Practice Address - Street 1:1108 WOODSON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1053
Practice Address - Country:US
Practice Address - Phone:979-567-3244
Practice Address - Fax:409-567-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2015-03-25
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
TX675887Medicare Oscar/Certification