Healthcare Provider Details

I. General information

NPI: 1669832903
Provider Name (Legal Business Name): GUADALUPE COUNTY HOSPITAL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FAIRWAY
KYLE TX
78640-8791
US

IV. Provider business mailing address

1640 FAIRWAY
KYLE TX
78640-8791
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-1003
  • Fax: 512-268-1132
Mailing address:
  • Phone: 512-268-1003
  • Fax: 512-268-1132

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: MRS. SOON BURNAM
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-540-1249