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Organization
LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Active
Organization
LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Active
Other names
Colonial Pines Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
C BRUCE STRATTON (BOARD PRESIDENT)
(936) 336-7400
Entity
Organization
Contact information
Practice address
1203 FM 1277, SAN AUGUSTINE, TX 75972-1635
(936) 275-3412
(936) 275-5394
Mailing address
1500 WATERS RIDGE DR, SUITE 200, LEWISVILLE, TX 75057-6011
(972) 899-4152
(469) 312-3796
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
116419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001003341
—
TX
01
—
148994001
MEDICAID CO B
TX
Enumeration date
09/07/2005
Last updated
12/05/2022
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