# LIBERTY COUNTY HOSPITAL DISTRICT NO. 1

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Tree Lodge Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437117272
- **Authorized official:** MR. CHARLES BRUCE STRATTON (PRESIDENT)
- **Authorized official phone:** (936) 336-7422

## Contact information

- **Practice address:** 2711 PINE TREE RD., LONGVIEW, TX 75604-1646
- **Practice address phone:** (903) 759-3994
- **Practice address fax:** (903) 759-1439
- **Mailing address:** 4150 INTERNATIONAL PLAZA, SUITE 600, FORT WORTH, TX 76109-4831
- **Mailing address phone:** (817) 348-8959
- **Mailing address fax:** (817) 348-0466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 111739 | TX | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 02/10/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001004827 | — | TX |
| 01 | — | 004989 | MEDICAID VENDOR \# | TX |
| 05 | — | 165860101 | — | TX |