Provider Demographics
NPI:1871991802
Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-6600
Mailing Address - Street 1:1010 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76704-1711
Mailing Address - Country:US
Mailing Address - Phone:254-752-9774
Mailing Address - Fax:254-227-6007
Practice Address - Street 1:1010 DALLAS ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-1711
Practice Address - Country:US
Practice Address - Phone:254-752-9774
Practice Address - Fax:254-227-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140914314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility