Healthcare Provider Details

I. General information

NPI: 1417346339
Provider Name (Legal Business Name): UVALDE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RYAN ST
BOERNE TX
78006-2046
US

IV. Provider business mailing address

200 RYAN ST
BOERNE TX
78006-2046
US

V. Phone/Fax

Practice location:
  • Phone: 830-249-2594
  • Fax: 830-248-1314
Mailing address:
  • Phone: 830-249-2594
  • Fax: 830-248-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number139897
License Number StateTX

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGER
Credential:
Phone: 337-439-6600