Healthcare Provider Details

I. General information

NPI: 1114975653
Provider Name (Legal Business Name): REGENCY NURSING CENTER PARTNERS OF FRIO COUNTY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S ASH ST
PEARSALL TX
78061-3102
US

IV. Provider business mailing address

320 S ASH ST
PEARSALL TX
78061-3102
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-4197
  • Fax: 830-334-3224
Mailing address:
  • Phone: 830-334-4197
  • Fax: 830-334-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5013400001
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number116900
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number455847
License Number StateTX

VIII. Authorized Official

Name: MR. HEBER S LACERDA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 361-576-0694