# LIBERTY COUNTY HOSPITAL DISTRICT NO. 1

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial Pines Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962496836
- **Authorized official:** C BRUCE STRATTON (BOARD PRESIDENT)
- **Authorized official phone:** (936) 336-7400

## Contact information

- **Practice address:** 1203 FM 1277, SAN AUGUSTINE, TX 75972-1635
- **Practice address phone:** (936) 275-3412
- **Practice address fax:** (936) 275-5394
- **Mailing address:** 1500 WATERS RIDGE DR, SUITE 200, LEWISVILLE, TX 75057-6011
- **Mailing address phone:** (972) 899-4152
- **Mailing address fax:** (469) 312-3796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 116419 | TX | Yes |

## Other

- **Enumeration date:** 09/07/2005
- **Last updated:** 12/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001003341 | — | TX |
| 01 | — | 148994001 | MEDICAID CO B | TX |