Provider Demographics
NPI:1801160593
Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:VAL VERDE COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-775-8566
Mailing Address - Street 1:101 W GOODWIN AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6502
Mailing Address - Country:US
Mailing Address - Phone:361-576-0694
Mailing Address - Fax:361-576-5484
Practice Address - Street 1:3030 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2337
Practice Address - Country:US
Practice Address - Phone:210-924-8151
Practice Address - Fax:210-924-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313M00000X
332B00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020411Medicaid
TX001026484Medicaid
TX5051Medicaid
TX001020411Medicaid