Provider Demographics
NPI:1922181460
Name:VAN ZANDT HEALTHCARE PROPERTY INC.
Entity Type:Organization
Organization Name:VAN ZANDT HEALTHCARE PROPERTY INC.
Other - Org Name:ANDERSON NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-288-9123
Mailing Address - Street 1:13110 W HIGHWAY 290
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8523
Mailing Address - Country:US
Mailing Address - Phone:512-288-9123
Mailing Address - Fax:512-288-9120
Practice Address - Street 1:520 BRADBURN RD
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-2015
Practice Address - Country:US
Practice Address - Phone:903-962-4234
Practice Address - Fax:903-962-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000418002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000418002Medicaid
675320OtherMEDICARE PTAN