Provider Demographics
NPI:1902029473
Name:GOVALLE CARE CENTER
Entity Type:Organization
Organization Name:GOVALLE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:512-926-7871
Mailing Address - Street 1:3101 GOVALLE AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3020
Mailing Address - Country:US
Mailing Address - Phone:512-926-7871
Mailing Address - Fax:
Practice Address - Street 1:3101 GOVALLE AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3020
Practice Address - Country:US
Practice Address - Phone:512-926-7871
Practice Address - Fax:512-928-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119699314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676022Medicare ID - Type UnspecifiedMEDICARE VENDOR NUMBER