Liberty County Hospital District No 1
Organization Active NPI Rural Health Clinic/Center · Liberty, TX
NPI 1386401560 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1386401560
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- LIBERTY COUNTY HOSPITAL DISTRICT NO 1
- Practice address
- 1202 N Travis St
Liberty, TX 77575-3540 - Phone
- (281) 915-0749
- NPI assigned
- Mar 4, 2024
- Organization subpart
- No
Authorized official
- Name
- Rhonda Campbell
- Title
- Chief Executive Officer
- Phone
- (936) 336-7316
Other NPIs on the same Medicare enrollment 1
Related certifications (CCN) 1
Practitioners 34
-
Amanuel Abreha, M.D.
-
Joseph E T Bales, M.D.
-
Mark Ryan Boyle, MD
-
Stace Breland, DO
-
Kathe Anne Britt, RN
-
Dale Wayne Brock, APN
-
Meredith Gault Brown, M.D.
-
Brett Allen Burnett, M.D.
-
David Chiao, MD
-
Lindsay Fowler Dragos, M.D.
-
Stephanie Dunlop, M.D.
-
Michael Allen Freeto, M.D.
-
Denzil Kenneth Frost, D.O.
-
Nina Grena Herring, FNP-C, PMHNP-B
-
Nitin Mahajan, M.D.
-
Nicole Elaine Malouf, M.D.
-
Victoria Dianne Manning, FNP-BC
-
Heather Reed, PA-C
-
Nashid Shinthia, M.D.
-
Gregory Taroyan, MD
-
Mark Wilson, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2327123 | Liberty Dayton Medical Specialty Clinic | Certificate of waiver | Jul 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Rural health clinic certification: CCN 678577
- Legal name
- LIBERTY COUNTY HOSPITAL DISTRICT NO 1
- Doing business as
- LIBERTY DAYTON MEDICAL SPECIALTY CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 21, 2025
- Last certification
- Aug 21, 2025
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 1202 N Travis St
Liberty, TX 77575-3540 - Related CCNs
- 451375
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda Campbell |
Corporate Director |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Edward Pickett |
Corporate Director |
Jan 1, 2024 | |
| Charles Bruce Stratton |
Corporate Director |
Jan 1, 2024 | |
| Paul Henry |
Corporate Director |
Jan 1, 2024 | |
| Victor Barranco |
Corporate Director |
Jan 1, 2024 | |
| Dianna Van Tassell |
Corporate Director |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 |
All facility ownership & control disclosures 38
| Facility | Type | Role | Since |
|---|---|---|---|
| Liberty Dayton Regional Medical Center |
Hospital | Operational/Managerial Control | Oct 1, 2014 |
| Liberty Dayton Regional Medical Center |
Hospital | Operational/Managerial Control | Oct 1, 2014 |
| Cascades at Senior Rehab |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2014 |
| Jefferson Nursing and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Nov 30, 2014 Jan 1, 2015 Mar 21, 2025 |
| College Street Health Care Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2014 |
| The Phoenix Post-Acute |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2015 |
| Southland Rehabilitation and Healthcare Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2015 |
| Timberwood Nursing and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2015 |
| Bremond Nursing and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Pine Grove Nursing Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 31, 2017 |
| Briarcliff Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 31, 2017 |
| Colonial Pines Healthcare Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 31, 2017 |
| Cass Valley Healthcare Center |
Skilled nursing facility | Operational/Managerial Control (100%) | Apr 1, 2017 |
| Harbor Point Skilled Nursing |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| The Heights of Tomball |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| The Heights of Tyler |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Avir at North Houston |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| East View Healthcare |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Mason Creek Transitional Care of Katy |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Copperfield Healthcare and Rehabilitation |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Misty Willow Healthcare and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Legend Oaks Healthcare and Rehabilitation-Northwest Houston |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Avalon Place Kirbyville |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| The Courtyards at Pasadena |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Bridgecrest Rehabilitation Suites |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| River Pointe of Trinity Healthcare and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2021 |
| Legacy at Town Creek |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2018 |
| Pasadena Post Acute |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2022 |
| Whisperwood Nursing & Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Vidor Health & Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Fairfield Nursing & Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Greenbrier Nursing & Rehabilitation Center of Tyler |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Twin Oaks Health & Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Caprock Nursing & Rehabilitation |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Five Points Nursing and Rehabilitation |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Pine Tree Lodge Nursing Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Mesa Hills Post Acute |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2023 |
| Liberty Dayton Medical Clinic |
Rural health clinic | Operational/Managerial Control | May 4, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160919002678 | TX | Part B Supplier - Clinic/Group Practice | 3678766227 |
Receives reassigned benefits from 27 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: The Woodlands, TX; Liberty, TX |
| O20240524002571 | TX | Part a Provider - Rural Health Clinic | 3678766227 | Practice locations: Liberty, TX |
National Provider Directory
Locations
7107 Queenston Blvd
Houston, TX 77095
Phone (218) 463-7333
1202 N Travis St
Liberty, TX 77575
Phone (936) 334-0720
1201 N Travis St
Liberty, TX 77575
Phone (936) 334-8800
5502 4th St
Lubbock, TX 79416
Phone (806) 535-4418
4048 Red Bluff Rd
Pasadena, TX 77503
Phone (713) 477-7877
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1202 N Travis St
Liberty, TX 77575-3540
Mailing address
1353 N Travis St
Liberty, TX 77575-3549
Phone (936) 336-7316
Other names
- LIBERTY DAYTON MEDICAL SPECIALTY CLINIC
Other providers in Liberty, TX
- Danny Kyaw Khine
- Carissa Kathryn Kruckemeyer
- Jennifer Landaverde
- Liberty County Co-Op
- 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
- Liberty Dayton Community Hospital
All providers in Liberty, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.