Healthcare Provider Details

I. General information

NPI: 1780765131
Provider Name (Legal Business Name): GRANGER VILLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N COMMERCE
GRANGER TX
76530-0398
US

IV. Provider business mailing address

PO BOX 398
GRANGER TX
76530-0398
US

V. Phone/Fax

Practice location:
  • Phone: 512-859-2800
  • Fax: 512-859-2905
Mailing address:
  • Phone: 512-859-2800
  • Fax: 512-859-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number118542
License Number StateTX

VIII. Authorized Official

Name: MR. JOSEPH S BARTOSH
Title or Position: PRESIDENT
Credential:
Phone: 512-964-7053