Provider Demographics
NPI:1508911454
Name:VINCENT PERSONAL CARE HOME
Entity Type:Organization
Organization Name:VINCENT PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBY
Authorized Official - Middle Name:ILIENE
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-729-3157
Mailing Address - Street 1:458 LCR 635
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-3431
Mailing Address - Country:US
Mailing Address - Phone:254-729-3157
Mailing Address - Fax:254-729-2619
Practice Address - Street 1:458 LCR 635
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-3431
Practice Address - Country:US
Practice Address - Phone:254-729-3157
Practice Address - Fax:254-729-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000550310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility