Provider Demographics
NPI:1891991584
Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-631-5342
Mailing Address - Street 1:6850 RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2355
Mailing Address - Country:US
Mailing Address - Phone:817-514-4940
Mailing Address - Fax:817-514-2198
Practice Address - Street 1:6850 RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76148-2355
Practice Address - Country:US
Practice Address - Phone:817-514-4940
Practice Address - Fax:817-514-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015125Medicaid
676161Medicare Oscar/Certification