Provider Demographics
NPI:1164404091
Name:UVALDE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UVALDE COUNTY HOSPITAL AUTHORITY
Other - Org Name:KIRKWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER OF MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:2590 LOOP 337
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-8511
Mailing Address - Country:US
Mailing Address - Phone:830-620-0509
Mailing Address - Fax:830-620-5148
Practice Address - Street 1:2590 LOOP 337
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-8502
Practice Address - Country:US
Practice Address - Phone:830-620-0509
Practice Address - Fax:830-620-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109791314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026695Medicaid
455732Medicare Oscar/Certification