# CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gardendale Rehabilitation and Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316354954
- **Authorized official:** MR. DAVID K BYROM (CEO)
- **Authorized official phone:** (254) 248-6300

## Contact information

- **Practice address:** 1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
- **Practice address phone:** (903) 586-3626
- **Practice address fax:** (903) 586-2133
- **Mailing address:** 1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
- **Mailing address phone:** (903) 586-3626
- **Mailing address fax:** (903) 586-2133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2014
- **Last updated:** 07/15/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004986 | — | TX |