Provider Demographics
NPI:1164852562
Name:HRA VILLAGE, INC.
Entity Type:Organization
Organization Name:HRA VILLAGE, INC.
Other - Org Name:THE INDEPENDENCE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:SLOCUMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-935-4335
Mailing Address - Street 1:905 HIGHWAY 3 N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-4024
Mailing Address - Country:US
Mailing Address - Phone:409-935-4335
Mailing Address - Fax:409-935-4153
Practice Address - Street 1:905 HIGHWAY 3 N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4024
Practice Address - Country:US
Practice Address - Phone:409-935-4335
Practice Address - Fax:409-935-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101040310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility