MEDICARE: HEALTHCARE CENTER OF HENDERSON

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	110773	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4894720001	OTHER	TX	DMERC PROVIDER #
2	4912	OTHER	TX	VENDOR NUMBER

General Provider Information

NPI Number	:	1891792834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE CENTER OF HENDERSON

Provider Business Mailing Address
First Line	:	PO BOX 7230
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-7230
Country	:	US
Telephone Number	:	361-576-9454
Fax Number	:	361-576-2994

Provider Business Practice Location Address
First Line	:	200 SOUTHWOOD DR
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-3257
Country	:	US
Telephone Number	:	903-657-6506
Fax Number	:	903-655-8578

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. JAMES HOFFMAN
Credential	:	CPA
Telephone Number	:	361-576-9454

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	08/22/2020

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Directions to “HEALTHCARE CENTER OF HENDERSON ” Practice Location

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