Provider Demographics
NPI:1114165271
Name:HILL COUNTRY OUTREACH, INC.
Entity Type:Organization
Organization Name:HILL COUNTRY OUTREACH, INC.
Other - Org Name:DBA SERENITY GARDENS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BULKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-792-6886
Mailing Address - Street 1:600 LESLIE DR,
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-792-6886
Mailing Address - Fax:830-792-6965
Practice Address - Street 1:600 LESLIE DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-792-6886
Practice Address - Fax:830-792-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
TX136650310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility