Provider Demographics
NPI:1952709131
Name:STEPHENS MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STEPHENS MEMORIAL HOSPITAL DISTRICT
Other - Org Name:HERITAGE AT TURNER PARK HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-916-6100
Mailing Address - Street 1:200 S GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-4702
Mailing Address - Country:US
Mailing Address - Phone:254-559-2241
Mailing Address - Fax:254-559-6536
Practice Address - Street 1:820 SMALL ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5856
Practice Address - Country:US
Practice Address - Phone:972-262-1351
Practice Address - Fax:972-642-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005188Medicaid
TX455733Medicare Oscar/Certification