Provider Demographics
NPI:1366478521
Name:SOUTHWEST LTC KERRVILLE LTD.
Entity Type:Organization
Organization Name:SOUTHWEST LTC KERRVILLE LTD.
Other - Org Name:RIVER HILLS HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-468-1991
Mailing Address - Street 1:2090 BANDERA HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6634
Mailing Address - Country:US
Mailing Address - Phone:830-257-9900
Mailing Address - Fax:830-257-9901
Practice Address - Street 1:2090 BANDERA HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6634
Practice Address - Country:US
Practice Address - Phone:830-257-9900
Practice Address - Fax:830-257-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118277314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014330Medicaid
TX676114Medicare Oscar/Certification