MEDICARE: INCARNATE WORD RETIREMENT COMMUNITY, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility
2	253Z00000X	In Home Supportive Care Agency
3	314000000X	Skilled Nursing Facility
4	313M00000X	Nursing Facility/Intermediate Care Facility	000204	TX

General Provider Information

NPI Number	:	1720289036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCARNATE WORD RETIREMENT COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	4707 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6215
Country	:	US
Telephone Number	:	210-829-7561
Fax Number	:	210-829-1601

Provider Business Practice Location Address
First Line	:	4707 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6215
Country	:	US
Telephone Number	:	210-829-7561
Fax Number	:	210-829-1601

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PAUL HARRISON
Credential	:
Telephone Number	:	210-829-7561

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/02/2023

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