Basic Information
| Provider Information | |||||||||
| NPI: | 1487891669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAL VERDE COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINDSOR NURSING AND REHABILITATION CENTER OF SEGUIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307758566 | ||||||||
| FaxNumber: | 8307757690 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 EASTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SEGUIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781555133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303797777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8307783677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 126126 | 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 | 4572 | 05 | TX | MEDICAID | 206763902 | 05 | TX | MEDICAID | 001026414 | 05 | TX | MEDICAID |