Basic Information
| Provider Information | |||||||||
| NPI: | 1073952339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARM SPRINGS REHABILITATION HOSPITAL OF VICTORIA LLC | ||||||||
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| OtherOrganizationName: | PAM REHABILITATION HOSPITAL OF VICTORIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1828 GOOD HOPE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ENOLA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177319660 | ||||||||
| FaxNumber: | 7177319665 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 JAMES COLEMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779043100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618947830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | MISITANO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7177319660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 283X00000X | 100229 | TX | Y | Hospitals | Rehabilitation Hospital |
No ID Information.