Basic Information
| Provider Information | |||||||||
| NPI: | 1093273732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST WHARTON COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HERITAGE NURSING & REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 SANDY CORNER RD | ||||||||
| Address2: | |||||||||
| City: | EL CAMPO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774379535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795785250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5437 EISENHAUER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782183703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106469576 | ||||||||
| FaxNumber: | 2106533695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | SOECHTING | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 9795436251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 100297 | 05 | TX | MEDICAID |