Healthcare Provider Details

I. General information

NPI: 1811122534
Provider Name (Legal Business Name): GUADALUPE COUNTY HOSPITAL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W AUSTIN ST
LULING TX
78648-1741
US

IV. Provider business mailing address

501 W AUSTIN ST
LULING TX
78648-1741
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-5628
  • Fax: 830-875-5302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number130255
License Number StateTX

VIII. Authorized Official

Name: KODY GANN
Title or Position: CEO
Credential:
Phone: 830-401-7720