Provider Demographics
NPI:1760720684
Name:STRATFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STRATFORD HOSPITAL DISTRICT
Other - Org Name:LEGACY REHABILITATION AND LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:4033 W 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6129
Mailing Address - Country:US
Mailing Address - Phone:806-355-4488
Mailing Address - Fax:806-353-0885
Practice Address - Street 1:4033 W 51ST AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6129
Practice Address - Country:US
Practice Address - Phone:806-355-4488
Practice Address - Fax:806-353-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2015-02-09
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
676010Medicare Oscar/Certification