Basic Information
| Provider Information | |||||||||
| NPI: | 1770894883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAN HEALTHCARE PARTNERS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VAN HEALTHCARE LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 FAIR PARK DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756543208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036578969 | ||||||||
| FaxNumber: | 9036578960 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 S OAK ST | ||||||||
| Address2: | |||||||||
| City: | VAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757903529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039638641 | ||||||||
| FaxNumber: | 9039635413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | BURT | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9036578969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 4671 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001018703 | 05 | TX | MEDICAID |