Healthcare Provider Details

I. General information

NPI: 1952367427
Provider Name (Legal Business Name): SOUTHWOOD CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3759 VALLEY VIEW ROAD
AUSTIN TX
78704
US

IV. Provider business mailing address

3759 VALLEY VIEW ROAD
AUSTIN TX
78704
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-3436
  • Fax: 512-445-4211
Mailing address:
  • Phone: 512-443-3436
  • Fax: 512-445-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number116109
License Number StateTX

VIII. Authorized Official

Name: EDDIE PARADES
Title or Position: SR VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 210-493-3165