Provider Demographics
NPI:1760602759
Name:JOHN KNOX VILLAGES OF THE LOWER RIO GRANDE VALLEY, INC
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGES OF THE LOWER RIO GRANDE VALLEY, INC
Other - Org Name:JOHN KNOX VILLAGE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-4575
Mailing Address - Street 1:1300 S. BORDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7417
Mailing Address - Country:US
Mailing Address - Phone:956-968-4575
Mailing Address - Fax:956-968-4570
Practice Address - Street 1:1300 S. BORDER AVENUE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7417
Practice Address - Country:US
Practice Address - Phone:956-968-4575
Practice Address - Fax:956-968-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric