Provider Demographics
NPI:1073651410
Name:IHS AT HANOVER HOUSE INC
Entity Type:Organization
Organization Name:IHS AT HANOVER HOUSE INC
Other - Org Name:MOUNTAIN VIEW HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-544-2002
Mailing Address - Street 1:1600 MURCHISON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2828
Mailing Address - Country:US
Mailing Address - Phone:915-544-2002
Mailing Address - Fax:915-544-0696
Practice Address - Street 1:1600 MURCHISON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2828
Practice Address - Country:US
Practice Address - Phone:915-544-2002
Practice Address - Fax:915-544-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113582314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455471Medicare ID - Type UnspecifiedLTC