Basic Information
| Provider Information | |||||||||
| NPI: | 1497158927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ECTOR COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EL PASO HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11525 VISTA DEL SOL DRIVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158553636 | ||||||||
| FaxNumber: | 9158553839 | ||||||||
| Practice Location | |||||||||
| Address1: | 11525 VISTA DEL SOL DRIVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158553636 | ||||||||
| FaxNumber: | 9158553839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 09/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | WEBSTER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4326402407 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 005168 | 05 | TX | MEDICAID |