Provider Demographics
NPI:1700111754
Name:PECAN VALLEY HEALTHCARE LLC
Entity Type:Organization
Organization Name:PECAN VALLEY HEALTHCARE LLC
Other - Org Name:PECAN VALLEY REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-525-7993
Mailing Address - Street 1:8000 IH 10 W
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3802
Mailing Address - Country:US
Mailing Address - Phone:210-525-7993
Mailing Address - Fax:210-525-7992
Practice Address - Street 1:3838 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3556
Practice Address - Country:US
Practice Address - Phone:210-525-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129441314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104259OtherFACILITY ID
TX001017939Medicaid
TX104259OtherFACILITY ID