Provider Demographics
NPI:1891792834
Name:HEALTHCARE CENTER OF HENDERSON
Entity Type:Organization
Organization Name:HEALTHCARE CENTER OF HENDERSON
Other - Org Name:SOUTHWOOD NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
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 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-3257
Practice Address - Country:US
Practice Address - Phone:903-657-6506
Practice Address - Fax:903-655-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110773314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4894720001OtherDMERC PROVIDER #
TX4912OtherVENDOR NUMBER
TX675893Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER