NPIMap

Organization Active NPI

Liberty County Hospital District No 1

  • Rural Health Clinic/Center
  • Liberty, TX
National Provider Identifier
1679926992
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Practice address
1201 N Travis St
Liberty, TX 77575-3539
Phone
(936) 336-9175
Fax
(936) 336-8185
NPI assigned
Jul 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rhonda Campbell
Title
Ceo
Phone
(936) 336-7316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1201 N Travis St
Liberty, TX 77575-3539

Mailing address

1353 N Travis St
Liberty, TX 77575-3549
Phone (936) 336-7316

Other practice location 1

1353 N Travis St
Liberty, TX 77575-3549
Phone (936) 336-7316

Other identifiers 1

IdentifierTypeStateIssuer
284333606MedicaidTX

Other names 1

  • LIBERTY DAYTON MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160309000894 TX Part A Provider - Rural Health Clinic 3678766227 1 other NPI on this enrollment
Practice locations: Liberty, TX

Rural health clinic certification: CCN 673428

Legal name
LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Doing business as
LIBERTY DAYTON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 4, 2015
Last certification
Feb 2, 2026
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1201 N Travis St
Liberty, TX 77575-3539
Related CCNs
451375

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2088676Liberty Dayton Medical Clinic1201 N Travis, Liberty, TX 77575Certificate of waiverDec 15, 2026

National Provider Directory

National Provider Directory
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.

View all 39

Locations

1353 N Travis St
Liberty, TX 77575
Phone (936) 336-7316

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Rhonda Campbell Individual Corporate DirectorCeo Aug 24, 2020
W-2 Managing EmployeeCeo Aug 24, 2020
Edward Pickett Individual Corporate DirectorBoard Member Jan 4, 2017
Charles Bruce Stratton Individual Corporate DirectorPresident Board of Directors May 1, 2014
Liberty County Hospital District No 1 Organization, Liberty, TX Operational/Managerial Control May 4, 2015
Paul Henry Individual Corporate DirectorVice President Board of Director May 1, 2014
Victor Barranco Individual Corporate DirectorMember Board of Directors May 1, 2014
Dianna Van Tassell Individual W-2 Managing EmployeeBusiness Office Manager Oct 1, 2014

All facility ownership & control disclosures 37

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

FacilityTypeRoleSince
Liberty Dayton Regional Medical CenterLiberty, TX, CCN 451375 Hospital Operational/Managerial Control Oct 1, 2014
Liberty Dayton Regional Medical CenterLiberty, TX, CCN 45Z375 Hospital Operational/Managerial Control Oct 1, 2014
Cascades at Senior RehabPort Arthur, TX, CCN 675541 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
Jefferson Nursing and Rehabilitation CenterBeaumont, TX, CCN 676218 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 CenterBeaumont, TX, CCN 675695 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
The Phoenix Post-AcuteTexas City, TX, CCN 675743 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Southland Rehabilitation and Healthcare CenterLufkin, TX, CCN 675962 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Timberwood Nursing and Rehabilitation CenterLivingston, TX, CCN 455745 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Bremond Nursing and Rehabilitation CenterBremond, TX, CCN 675132 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Pine Grove Nursing CenterCenter, TX, CCN 675230 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Briarcliff Skilled Nursing FacilityCarthage, TX, CCN 676051 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Colonial Pines Healthcare CenterSan Augustine, TX, CCN 675358 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 31, 2017
Cass Valley Healthcare CenterCenterville, TX, CCN 675065 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2017
Harbor Point Skilled NursingTexas City, TX, CCN 675214 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
The Heights of TomballTomball, TX, CCN 676350 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
The Heights of TylerTyler, TX, CCN 676262 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avir at North HoustonHouston, TX, CCN 676356 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
East View HealthcareHouston, TX, CCN 676081 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Mason Creek Transitional Care of KatyKaty, TX, CCN 676194 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Copperfield Healthcare and RehabilitationHouston, TX, CCN 676230 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Misty Willow Healthcare and Rehabilitation CenterHouston, TX, CCN 676251 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Legend Oaks Healthcare and Rehabilitation-Northwest HoustonHouston, TX, CCN 676137 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avalon Place KirbyvilleKirbyville, TX, CCN 675220 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
The Courtyards at PasadenaPasadena, TX, CCN 676155 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Bridgecrest Rehabilitation SuitesHouston, TX, CCN 676362 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
River Pointe of Trinity Healthcare and Rehabilitation CenterTrinity, TX, CCN 675900 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2021
Legacy at Town CreekPalestine, TX, CCN 675998 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Pasadena Post AcutePasadena, TX, CCN 675365 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2022
Whisperwood Nursing & Rehabilitation CenterLubbock, TX, CCN 675527 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Vidor Health & Rehabilitation CenterVidor, TX, CCN 676108 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2022
Fairfield Nursing & Rehabilitation CenterFairfeild, TX, CCN 676123 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Greenbrier Nursing & Rehabilitation Center of TylerTyler, TX, CCN 675267 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Twin Oaks Health & Rehabilitation CenterJacksonville, TX, CCN 675183 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Caprock Nursing & RehabilitationBorger, TX, CCN 676341 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2022
Five Points Nursing and RehabilitationAmarillo, TX, CCN 676455 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Pine Tree Lodge Nursing CenterLongview, TX, CCN 675177 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Mesa Hills Post AcuteBrownsville, TX, CCN 455423 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2023

Facilities with the same owner 37

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

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1679926992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 N TRAVIS ST",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753549",
            "telephone_number": "936-336-7316",
            "fax_number": "936-336-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N TRAVIS ST",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753539",
            "telephone_number": "936-336-9175",
            "fax_number": "936-336-8185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1353 N Travis St",
            "address_purpose": "LOCATION",
            "city": "Liberty",
            "state": "TX",
            "postal_code": "775753549",
            "country_code": "US",
            "telephone_number": "936-336-7316",
            "fax_number": "936-336-2280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIBERTY COUNTY HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "936-336-7316",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284333606",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIBERTY DAYTON MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIBERTY DAYTON MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, TX

Sources for this page

Verify at the official NPI Registry.