Provider Demographics
NPI:1023576865
Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WEST WHARTON COUNTY HOSPITAL DISTRICT
Other - Org Name:LAKESIDE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-569-7370
Mailing Address - Street 1:303 SANDY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9535
Mailing Address - Country:US
Mailing Address - Phone:979-578-5250
Mailing Address - Fax:
Practice Address - Street 1:8707 LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3245
Practice Address - Country:US
Practice Address - Phone:210-510-3200
Practice Address - Fax:210-645-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5634Medicaid
TX001030439Medicaid
TX105220Medicaid