Provider Demographics
NPI:1043880123
Name:LION STAR NACOGDOCHES HOSPITAL, LLC
Entity type:Organization
Organization Name:LION STAR NACOGDOCHES HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:936-568-8523
Mailing Address - Street 1:707 WOODS ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4411
Mailing Address - Country:US
Mailing Address - Phone:936-568-8488
Mailing Address - Fax:
Practice Address - Street 1:707 WOODS ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4411
Practice Address - Country:US
Practice Address - Phone:936-568-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit