Provider Demographics
NPI:1760478200
Name:GUADALUPE COUNTY HOSPITAL BOARD
Entity Type:Organization
Organization Name:GUADALUPE COUNTY HOSPITAL BOARD
Other - Org Name:NORTHEAST REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER OF MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:603 CORINNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3303
Mailing Address - Country:US
Mailing Address - Phone:210-824-7331
Mailing Address - Fax:210-824-7331
Practice Address - Street 1:603 CORINNE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3303
Practice Address - Country:US
Practice Address - Phone:210-824-7331
Practice Address - Fax:210-824-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111489314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004268Medicaid
TX455754Medicare Oscar/Certification