Provider Demographics
NPI:1740608629
Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Other - Org Name:SBS LEASECO CHANDLER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-729-3281
Mailing Address - Street 1:701 MCCLINTIC DR
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2128
Mailing Address - Country:US
Mailing Address - Phone:254-729-3281
Mailing Address - Fax:254-729-2689
Practice Address - Street 1:300 CHERRY ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758-9636
Practice Address - Country:US
Practice Address - Phone:903-849-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139673314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-5910OtherMEDICARE
001025840OtherMEDICARE PROVIDER NUMBER
TX5223Medicaid