Provider Demographics
NPI:1053312090
Name:CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
Other - Org Name:CHRISTUS SANTA ROSA HOSPITAL - NEW BRAUNFELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-704-2665
Mailing Address - Street 1:600 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4194
Mailing Address - Country:US
Mailing Address - Phone:830-606-9111
Mailing Address - Fax:830-643-6174
Practice Address - Street 1:600 N UNION AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4194
Practice Address - Country:US
Practice Address - Phone:830-606-9111
Practice Address - Fax:830-643-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000415282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137998405Medicaid
TX137998405Medicaid