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	111489	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760478200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUADALUPE COUNTY HOSPITAL BOARD

Provider Business Mailing Address
First Line	:	603 CORINNE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3303
Country	:	US
Telephone Number	:	210-824-7331
Fax Number	:	210-824-7331

Provider Business Practice Location Address
First Line	:	603 CORINNE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3303
Country	:	US
Telephone Number	:	210-824-7331
Fax Number	:	210-824-1334

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/10/2022

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