Organization
SOUTH LIMESTONE HOSPITAL DISTRICT
Active
Other names
Providence Park Rehabilitation and Skilled Nursing
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY N. PRICE (CEO)
(254) 729-3281
Entity
Organization
Contact information
Practice address
5505 NEW COPELAND RD, TYLER, TX 75703-3955
(903) 939-2443
(903) 939-2479
Mailing address
1500 WATERS RIDGE DR STE 200, LEWISVILLE, TX 75057-6056
(214) 899-4126
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
124617
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001021325
—
TX
01
—
197010501
MCD CO B
TX
Enumeration date
02/29/2008
Last updated
04/06/2020
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