NPIMap

Organization Active NPI

Nacogdoches County Hospital District

  • Skilled Nursing Facility
  • Longview, TX
National Provider Identifier
1871981019
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
136092 Issued in TX
Legal business name
NACOGDOCHES COUNTY HOSPITAL DISTRICT
Practice address
112 Ruthlynn Dr
Longview, TX 75605-5634
Phone
(903) 753-8611
Fax
(903) 758-4026
NPI assigned
Dec 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Ronald R Payne
Title
Manager
Phone
(469) 916-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 136092 TX Primary

Addresses

Primary practice location

112 Ruthlynn Dr
Longview, TX 75605-5634

Mailing address

1204 N Mound St
Nacogdoches, TX 75961-4027
Phone (936) 568-8523

Other identifiers 1

IdentifierTypeStateIssuer
005129MedicaidTX

Other names 1

  • Heritage at Longview Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170824003277 TX Part A Provider - Skilled Nursing Facility 0446151328 Practice locations: Longview, TX

Skilled nursing facility certification: CCN 455569

Legal name
NACOGDOCHES COUNTY HOSPITAL DISTRICT
Doing business as
HERITAGE AT LONGVIEW HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Aug 8, 1985
Last certification
Jun 5, 2024
Beds
150 (140 certified)
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Creative Solutions in Healthcare
Most recent change of ownership
Apr 1, 2017
Organization structure
OtherNon-profit
Enrollment address
112 Ruthlynn Drive
Longview, TX 75605-5634
Nursing home name
HERITAGE AT LONGVIEW HEALTHCARE CENTER
Affiliated entity
CREATIVE SOLUTIONS IN HEALTHCARE

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage at Longview Healthcare CenterCCN 455569
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 8, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14051.2 residents per day on average
Chain
Creative Solutions in Healthcare149 facilities in the chain
Penalties (3 years)
2Fines totaling $81,752

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Nacogdoches Memorial Ho14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Tyler Lange Individual W-2 Managing Employee Jul 15, 2022 100%
Sean Hightower Individual Other Jan 1, 2022 20%
Southwest LTC - Longview LLC Organization, Plano, TX Management services company, For-profit Operational/Managerial Control Apr 1, 2017 100%
Lisa a King Individual OtherBoard President Apr 1, 2017 20%
Fred Grover Individual Other Jan 1, 2022
Lynn Lindsey Individual Corporate Officer Jan 1, 2022 100%
Wes McKnight Individual Other Jan 1, 2022 20%
Justin Sowell Individual Other Jan 1, 2022 20%

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Nacogdoches Memorial HospitalNacogdoches, TX, CCN 45S508 Hospital Operational/Managerial Control (100%) Jul 1, 2015
Cecil R. Bomar Rehabilitation CenterNacogdoches, TX, CCN 45T508 Hospital Operational/Managerial Control (100%) Mar 11, 2024
Stonecreek Nursing & RehabilitationSan Augustine, TX, CCN 675729 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2017

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1871981019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614027",
            "telephone_number": "936-568-8523",
            "fax_number": "936-568-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 RUTHLYNN DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055634",
            "telephone_number": "903-753-8611",
            "fax_number": "903-758-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NACOGDOCHES COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-22",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "136092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005129",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage at Longview Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage at Longview Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.