Healthcare Provider Details

I. General information

NPI: 1912289356
Provider Name (Legal Business Name): ESL VICTORIA OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E LARKSPUR ST
VICTORIA TX
77904-2661
US

IV. Provider business mailing address

9510 ORMSBY STATION RD SUITE 101
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 361-576-0444
  • Fax: 361-576-2551
Mailing address:
  • Phone: 502-753-6004
  • Fax: 502-753-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN L BARBER
Title or Position: VICE PRESIDENT
Credential: JD
Phone: 502-753-6004