Provider Demographics
NPI:1003215492
Name:DEWITT MEDICAL DISTRICT
Entity Type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:FLORESVILLE RESIDENCE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-275-0504
Mailing Address - Street 1:1811 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-2761
Mailing Address - Country:US
Mailing Address - Phone:830-393-2561
Mailing Address - Fax:830-393-8817
Practice Address - Street 1:1811 6TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2761
Practice Address - Country:US
Practice Address - Phone:830-393-2561
Practice Address - Fax:830-393-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004552Medicaid
TX004552Medicaid