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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1770197287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCARNATE WORD RETIREMENT COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	17621 STATE HIGHWAY 95
Second Line	:
City	:	HOLLAND
State	:	TX
Zip	:	76534-4422
Country	:	US
Telephone Number	:	512-868-7567
Fax Number	:

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	:	210-828-0020

Authorized Official
Title or Position	:	VP OF FINANCE AND CFO
Name	:	JOAN DIXON
Credential	:
Telephone Number	:	210-829-7561

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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