Healthcare Provider Details

I. General information

NPI: 1659342160
Provider Name (Legal Business Name): STATE OF TEXAS VETERANS LAND BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 KENWORTHY ST
EL PASO TX
79924-6011
US

IV. Provider business mailing address

1700 CONGRESS AVE RM 810
AUSTIN TX
78701-1496
US

V. Phone/Fax

Practice location:
  • Phone: 915-751-0967
  • Fax: 915-751-0980
Mailing address:
  • Phone: 512-936-6929
  • Fax: 512-475-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number102314
License Number StateTX

VIII. Authorized Official

Name: MR. JERRY E PATTERSON
Title or Position: CHAIRMAN TEXAS VETERANS LAND BOARD
Credential:
Phone: 512-475-2336