Liberty County Hospital District No 1

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LIBERTY COUNTY HOSPITAL DISTRICT NO 1

Practice address

12921 Misty Willow Dr
Houston, TX 77070-5287

Phone

(281) 469-7881

Fax

(281) 469-2169

NPI assigned

Feb 26, 2016

Organization subpart

No

Name

Soon Burnam

Title

Treasurer of Management Company

Phone

(949) 540-1249

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Nida Fatema Ali, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1548555642

  Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

  CMS ownership

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Liberty County Hospital District No 1

  • Critical Access Hospital
  • Liberty, TX
  • NPI 1154324952

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Texas City, TX
  • NPI 1255627238

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Beaumont, TX
  • NPI 1326141557

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Kirbyville, TX
  • NPI 1447200118

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Brownsville, TX
  • NPI 1447961156

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Livingston, TX
  • NPI 1528015237

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Katy, TX
  • NPI 1659731081

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Rural Health Clinic/Center
  • Liberty, TX
  • NPI 1679926992

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1801239033

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Bremond, TX
  • NPI 1841495504

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1891156733

  Liberty County Hospital District No 1

  CMS ownership
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Pasadena, TX
  • NPI 1912125683

  Liberty County Hospital District No 1

  CMS ownership

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nida Fatema Ali, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1548555642
  NPD (past)
• Ricardo E Cuadra, MD

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1144251372
  NPD (past)
• Paul Van Nguyen, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1831300839
  NPD (past)
• Hoang-Anh Lac Phan, D.O

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1407020035
  NPD (past)

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Nida Fatema Ali, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1548555642

  Nursing home

  Care Compare affiliation
• Varun Kumar

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1720498967

  Nursing home

  Care Compare affiliation
• Paul Van Nguyen, MD

  • Family Medicine Physician
  • Houston, TX
  • NPI 1831300839

  Nursing home

  Care Compare affiliation
• Hoang-Anh Lac Phan, D.O

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1407020035

  Nursing home

  Care Compare affiliation

Listed as

Misty Willow Healthcare and Rehabilitation CenterCCN 676251

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Apr 21, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12489.8 residents per day on average

Chain

The Ensign Group342 facilities in the chain

Special focus status

SFF Candidate

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

3Fines totaling $79,412

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Skilled nursing facility certification: CCN 676251

Legal name

LIBERTY COUNTY HOSPITAL DISTRICT NO 1

Doing business as

MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 21, 2010

Last certification

Aug 30, 2024

Beds

124

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Keystone Care, LLC

Organization structure

OtherNon-profit

Enrollment address

12921 Misty Willow Dr
Houston, TX 77070-5287

Nursing home name

MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER

Affiliated entity

THE ENSIGN GROUP

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Tax ID family

Liberty County Hospital District No140 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Texas City, TX
  • NPI 1255627238
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Beaumont, TX
  • NPI 1326141557
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Kirbyville, TX
  • NPI 1447200118
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Brownsville, TX
  • NPI 1447961156
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1598170755
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Katy, TX
  • NPI 1659731081
  NPD tax ID
• Liberty County Hospital District No 1

  • Rural Health Clinic/Center
  • Liberty, TX
  • NPI 1679926992
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1801239033
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Bremond, TX
  • NPI 1841495504
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1891156733
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Pasadena, TX
  • NPI 1912125683
  NPD tax ID
• Liberty County Hospital District No 1

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1922469956
  NPD tax ID

• Misty Willow Healthcare and Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 1, 2021.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1003276437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12921 MISTY WILLOW DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770705287",
            "telephone_number": "281-469-7881",
            "fax_number": "281-469-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12921 MISTY WILLOW DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770705287",
            "telephone_number": "281-469-7881",
            "fax_number": "281-469-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY COUNTY HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER OF MANAGEMENT COMPANY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Misty Willow Healthcare and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Misty Willow Healthcare and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles L Libby, PT
• Liberated Minds TX Counseling PLLC
• Christine Liberatore, R.D.
• Tyler J Liberatore, MA, LBA, BCBA
• Shari Rachel Liberman, MD
• Liberty County Hospital District No 1
• Liberty County Hospital District No 1
• Liberty County Hospital District No 1
• Liberty County Hospital District No 1
• Liberty County Hospital District No. 1

• All providers in Houston, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.