Provider Demographics
NPI:1093712432
Name:SOUTHLAND VILLA CARE CENTER
Entity Type:Organization
Organization Name:SOUTHLAND VILLA CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-773-1641
Mailing Address - Street 1:2222 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7446
Mailing Address - Country:US
Mailing Address - Phone:254-773-1641
Mailing Address - Fax:254-773-3227
Practice Address - Street 1:2222 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7446
Practice Address - Country:US
Practice Address - Phone:254-773-1641
Practice Address - Fax:254-773-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675326Medicare ID - Type Unspecified