Provider Demographics
NPI:1659763795
Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Other - Org Name:AMISTAD NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-9454
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-7230
Mailing Address - Country:US
Mailing Address - Phone:361-576-9454
Mailing Address - Fax:361-576-2994
Practice Address - Street 1:200 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5727
Practice Address - Country:US
Practice Address - Phone:830-278-5641
Practice Address - Fax:830-278-5361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAL VERDE COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139516314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4216Medicaid
TX455536Medicare Oscar/Certification