Provider Demographics
NPI:1952322851
Name:HAMILTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HAMILTON COUNTY HOSPITAL DISTRICT
Other - Org Name:THE LAURENWOOD NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-386-1950
Mailing Address - Street 1:330 W CAMP WISDOM RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3331
Mailing Address - Country:US
Mailing Address - Phone:972-298-3398
Mailing Address - Fax:972-709-4090
Practice Address - Street 1:330 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3331
Practice Address - Country:US
Practice Address - Phone:972-298-3398
Practice Address - Fax:972-709-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111878314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000451204Medicaid
TX3955460001Medicare NSC
TX675806Medicare ID - Type UnspecifiedPROVIDER NUMBER