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General NPI Number Information
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NPI Number | 1093712432
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Entity Type | Organization
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Legal Business Name | SOUTHLAND VILLA CARE CENTER
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2222 S 5TH ST
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City | TEMPLE
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State | TX
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Zip | 76504-7446
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Country | US
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Telephone | 254-773-1641
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Fax | 254-773-3227
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Provider Business Mailing Address
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Address Line | 2222 S 5TH ST
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City | TEMPLE
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State | TX
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Zip | 76504-7446
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Country | US
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Telephone | 254-773-1641
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Fax | 254-773-3227
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DENNIS A HORSCH
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Credential |
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Telephone | 254-773-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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