Healthcare Provider Details

I. General information

NPI: 1205884749
Provider Name (Legal Business Name): VAL VERDE COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MEDICAL DR
PEARSALL TX
78061-6604
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 830-334-3371
  • Fax: 830-334-2001
Mailing address:
  • Phone: 361-576-0694
  • Fax: 361-576-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number115119
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3873900001
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number455797
License Number StateTX

VIII. Authorized Official

Name: MR. ANTONIO SOTELO
Title or Position: CHAIRMAN
Credential:
Phone: 830-775-8566