Basic Information
| Provider Information | |||||||||
| NPI: | 1023255205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAL VERDE COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VAL VERDE NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W GOODWIN AVE | ||||||||
| Address2: | STE 600 | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779016502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615760694 | ||||||||
| FaxNumber: | 3615765484 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HERRMANN DR | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307757477 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | SOTELO | ||||||||
| AuthorizedOfficialFirstName: | ANTONIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 8307758566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | 313M00000X | 129270 | TX | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001016605 | 05 | TX | MEDICAID | 209613301 | 05 | TX | MEDICAID | 001026413 | 05 | TX | MEDICAID | 4543 | 05 | TX | MEDICAID |