Healthcare Provider Details

I. General information

NPI: 1578956355
Provider Name (Legal Business Name): GUADALUPE COUNTY HOSPITAL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FM 971
GEORGETOWN TX
78626-4546
US

IV. Provider business mailing address

1215 E. COURT STREET
SEGUIN TX
78155
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-6200
  • Fax:
Mailing address:
  • Phone: 830-379-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PENNY WALLACE
Title or Position: CFO
Credential:
Phone: 830-379-2411