Basic Information
| Provider Information | |||||||||
| NPI: | 1477801934 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PECAN VALLEY NURSING AND REHAB CENTER LLC | ||||||||
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| OtherOrganizationName: | PECAN VALLEY NURSING AND REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758401603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033891009 | ||||||||
| FaxNumber: | 9033891090 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 W STOREY ST | ||||||||
| Address2: | |||||||||
| City: | SAN SABA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768776422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3253725112 | ||||||||
| FaxNumber: | 3253725114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUMPASS | ||||||||
| AuthorizedOfficialFirstName: | DUDLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2547163614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.