Healthcare Provider Details

I. General information

NPI: 1922181460
Provider Name (Legal Business Name): VAN ZANDT HEALTHCARE PROPERTY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BRADBURN RD
GRAND SALINE TX
75140-2015
US

IV. Provider business mailing address

13110 W HIGHWAY 290 SUITE 103
AUSTIN TX
78737-8523
US

V. Phone/Fax

Practice location:
  • Phone: 903-962-4234
  • Fax: 903-962-3517
Mailing address:
  • Phone: 512-288-9123
  • Fax: 512-288-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000418002
License Number StateTX

VIII. Authorized Official

Name: MR. ALLAN W. CHALBERG
Title or Position: VICE-PRES.
Credential:
Phone: 512-288-9123