Healthcare Provider Details

I. General information

NPI: 1710941075
Provider Name (Legal Business Name): REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 VILLAGE RD
PORT LAVACA TX
77979-2380
US

IV. Provider business mailing address

524 VILLAGE RD
PORT LAVACA TX
77979-2380
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-3741
  • Fax: 361-552-5808
Mailing address:
  • Phone: 361-552-3741
  • Fax: 361-552-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number113221
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4142560001
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number455999
License Number StateTX

VIII. Authorized Official

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