Healthcare Provider Details

I. General information

NPI: 1568450971
Provider Name (Legal Business Name): HILL COUNTRY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E GREEN ST
LLANO TX
78643-2717
US

IV. Provider business mailing address

507 E GREEN ST
LLANO TX
78643-2717
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-4115
  • Fax: 325-247-3978
Mailing address:
  • Phone: 325-247-4115
  • Fax: 325-247-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110706
License Number StateTX

VIII. Authorized Official

Name: MR. JAMES MICHAEL SHAW
Title or Position: ADMINISTRATOR
Credential: LNFA
Phone: 325-247-4115