Provider Demographics
NPI:1023455201
Name:VICTORIA TX SNF MANAGEMENT LLC
Entity type:Organization
Organization Name:VICTORIA TX SNF MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-747-8077
Mailing Address - Street 1:114 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3101
Practice Address - Country:US
Practice Address - Phone:361-576-6128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility