Provider Demographics
NPI:1265487706
Name:VICTORIA OF TEXAS LP
Entity Type:Organization
Organization Name:VICTORIA OF TEXAS LP
Other - Org Name:DETAR HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-2089
Mailing Address - Country:US
Mailing Address - Phone:361-575-7441
Mailing Address - Fax:361-788-6114
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6050
Practice Address - Country:US
Practice Address - Phone:361-575-0228
Practice Address - Fax:361-575-0782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORIA OF TEXAS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000453314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-5768Medicare Oscar/Certification