Provider Demographics
NPI:1467678615
Name:STATE OF TEXAS VETERANS LAND BOARD
Entity Type:Organization
Organization Name:STATE OF TEXAS VETERANS LAND BOARD
Other - Org Name:USSERY-ROAN TEXAS STATE VETERANS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, TEXAS VETERANS LAND BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-475-2336
Mailing Address - Street 1:1700 NORTH CONGRESS AVENUE
Mailing Address - Street 2:RM 810
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1496
Mailing Address - Country:US
Mailing Address - Phone:512-936-6929
Mailing Address - Fax:512-475-2294
Practice Address - Street 1:1020 TASCOSA ROAD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1504
Practice Address - Country:US
Practice Address - Phone:806-322-8387
Practice Address - Fax:806-683-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
TX100260314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015095Medicaid
TX001003040Medicaid
TX676157Medicare Oscar/Certification