Healthcare Provider Details

I. General information

NPI: 1407853427
Provider Name (Legal Business Name): CARE CENTER LUMBERTON, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N MAIN ST
LUMBERTON TX
77657-7356
US

IV. Provider business mailing address

PO BOX 7230
VICTORIA TX
77903-7230
US

V. Phone/Fax

Practice location:
  • Phone: 409-755-0100
  • Fax: 409-755-4200
Mailing address:
  • Phone: 361-576-9454
  • Fax: 361-576-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number111588
License Number StateTX

VIII. Authorized Official

Name: MR. JAMES HOFFMAN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: CPA
Phone: 361-576-9454