Provider Demographics
NPI:1497026363
Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Other - Org Name:EBONY LAKE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-778-3677
Mailing Address - Street 1:1001 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7533
Mailing Address - Country:US
Mailing Address - Phone:956-541-0917
Mailing Address - Fax:956-541-2860
Practice Address - Street 1:1001 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7533
Practice Address - Country:US
Practice Address - Phone:956-541-0917
Practice Address - Fax:956-541-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005259Medicaid
TX001027423Medicaid
TX374303101Medicaid
TX6899530001Medicare NSC