Provider Demographics
NPI:1770197287
Name:INCARNATE WORD RETIREMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:INCARNATE WORD RETIREMENT COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-829-7561
Mailing Address - Street 1:17621 STATE HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76534-4422
Mailing Address - Country:US
Mailing Address - Phone:512-868-7567
Mailing Address - Fax:
Practice Address - Street 1:4707 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6215
Practice Address - Country:US
Practice Address - Phone:210-829-7561
Practice Address - Fax:210-828-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility