Provider Demographics
NPI:1972902245
Name:TITUS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TITUS COUNTY HOSPITAL DISTRICT
Other - Org Name:PINECREST NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-577-6066
Mailing Address - Street 1:3505 OLD JACKSONVIL RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8510
Mailing Address - Country:US
Mailing Address - Phone:903-561-2011
Mailing Address - Fax:903-534-8335
Practice Address - Street 1:3505 OLD JACKSONVIL RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8510
Practice Address - Country:US
Practice Address - Phone:903-561-2011
Practice Address - Fax:903-534-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005181Medicaid
TX675289Medicare Oscar/Certification