Provider Demographics
NPI:1558960070
Name:BLANCO VILLA OP LLC
Entity Type:Organization
Organization Name:BLANCO VILLA OP LLC
Other - Org Name:ASBURY CARE CENTER OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-344-4553
Mailing Address - Street 1:8020 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3702
Mailing Address - Country:US
Mailing Address - Phone:210-344-4553
Mailing Address - Fax:210-366-3728
Practice Address - Street 1:8020 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3702
Practice Address - Country:US
Practice Address - Phone:210-344-4553
Practice Address - Fax:210-366-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility