Organization
LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
Active
Other names
Pine Tree Lodge Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES BRUCE STRATTON (PRESIDENT)
(936) 336-7422
Entity
Organization
Contact information
Practice address
2711 PINE TREE RD., LONGVIEW, TX 75604-1646
(903) 759-3994
(903) 759-1439
Mailing address
4150 INTERNATIONAL PLAZA, SUITE 600, FORT WORTH, TX 76109-4831
(817) 348-8959
(817) 348-0466
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
111739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004827
—
TX
01
—
004989
MEDICAID VENDOR #
TX
05
—
165860101
—
TX
Enumeration date
05/02/2006
Last updated
02/10/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us