Provider Demographics
NPI:1922081181
Name:GUADALUPE COUNTY HOSPITAL BOARD
Entity Type:Organization
Organization Name:GUADALUPE COUNTY HOSPITAL BOARD
Other - Org Name:MORNINGSIDE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-401-7721
Mailing Address - Street 1:1215 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5129
Mailing Address - Country:US
Mailing Address - Phone:830-410-7220
Mailing Address - Fax:
Practice Address - Street 1:602 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3101
Practice Address - Country:US
Practice Address - Phone:210-731-1000
Practice Address - Fax:210-731-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111720314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001028630Medicaid
TX455523Medicare Oscar/Certification