MEDICARE: GUADALUPE COUNTY HOSPITAL BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		TX

General Provider Information

NPI Number	:	1235671629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUADALUPE COUNTY HOSPITAL BOARD

Provider Business Mailing Address
First Line	:	2 TOWERS PARK LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6410
Country	:	US
Telephone Number	:	210-829-1400
Fax Number	:	210-841-7700

Provider Business Practice Location Address
First Line	:	2 TOWERS PARK LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6410
Country	:	US
Telephone Number	:	210-829-1400
Fax Number	:	210-841-7700

Authorized Official
Title or Position	:	SECRETARY OF MANAGEMENT COMPANY
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	04/07/2026

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