Basic Information
| Provider Information | |||||||||
| NPI: | 1851842116 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAN SENIOR CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VAN HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W STATE HIGHWAY 6 | ||||||||
| Address2: | SUITE 612 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767127923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547320797 | ||||||||
| FaxNumber: | 2543996766 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 S. OAK ST. | ||||||||
| Address2: | |||||||||
| City: | VAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039638641 | ||||||||
| FaxNumber: | 9039635413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2547320797 | ||||||||
| 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 |
No ID Information.