Healthcare Provider Details

I. General information

NPI: 1487880704
Provider Name (Legal Business Name): LONGHORN VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 LONGHORN PKWY
AUSTIN TX
78732-1204
US

IV. Provider business mailing address

12501 LONGHORN PARKWAY
AUSTIN TX
78732-1267
US

V. Phone/Fax

Practice location:
  • Phone: 512-266-5600
  • Fax: 512-266-5601
Mailing address:
  • Phone: 512-266-5600
  • Fax: 512-266-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number137833
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number103910
License Number StateTX

VIII. Authorized Official

Name: LOWELL ARELLANO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 512-507-4699