Healthcare Provider Details

I. General information

NPI: 1851008981
Provider Name (Legal Business Name): GUADALUPE COUNTY HOSPITAL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOLLYBROOK DR
LONGVIEW TX
75605-2461
US

IV. Provider business mailing address

301 HOLLYBROOK DR
LONGVIEW TX
75605-2461
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-7764
  • Fax: 903-758-6462
Mailing address:
  • Phone: 903-758-7764
  • Fax: 903-758-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KODY GAN
Title or Position: CFO
Credential:
Phone: 830-401-7721