Provider Demographics
NPI:1982698742
Name:HAMILTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HAMILTON COUNTY HOSPITAL DISTRICT
Other - Org Name:THE EDEN OF LAS COLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER OF MANAGEMENT COMPANY
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 1:2101 W NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2650
Mailing Address - Country:US
Mailing Address - Phone:972-255-4460
Mailing Address - Fax:972-258-8084
Practice Address - Street 1:2101 WEST NORTHGATE DR.
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2637
Practice Address - Country:US
Practice Address - Phone:972-255-4460
Practice Address - Fax:972-252-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110791314000000X
TX130536314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004663Medicaid
TX159891401OtherMEDICAID CO B
AZ675967Medicare Oscar/Certification