Healthcare Provider Details

I. General information

NPI: 1013972447
Provider Name (Legal Business Name): ELGIN GOLDEN YEARS NURSING AND REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HWY 290
ELGIN TX
78621-2510
US

IV. Provider business mailing address

605 HWY 290
ELGIN TX
78621-2510
US

V. Phone/Fax

Practice location:
  • Phone: 512-281-3413
  • Fax: 512-281-3016
Mailing address:
  • Phone: 512-281-3413
  • Fax: 512-281-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number115129
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1225160001
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number675725
License Number StateTX

VIII. Authorized Official

Name: HEBER S LACERDA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 361-576-0694