Healthcare Provider Details

I. General information

NPI: 1104063387
Provider Name (Legal Business Name): WINDSOR NURSING CENTER PARTNERS OF LLANO, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W HAYNIE ST
LLANO TX
78643-1905
US

IV. Provider business mailing address

101 W GOODWIN AVE STE 600
VICTORIA TX
77901-6502
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-4194
  • Fax:
Mailing address:
  • Phone: 361-576-0694
  • 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: MR. HEBER S. LACERDA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 361-576-0694