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General NPI Number Information
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NPI Number | 1164419958
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Entity Type | Organization
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Legal Business Name | HIDALGO NURSING HOME LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1013 S BRYAN RD
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City | MISSION
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State | TX
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Zip | 78572-6608
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Country | US
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Telephone | 512-458-5707
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Fax | 512-458-5751
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Provider Business Mailing Address
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Address Line | 6633 E HIGHWAY 290 STE 202
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City | AUSTIN
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State | TX
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Zip | 78723-1157
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Country | US
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Telephone | 512-458-5707
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Fax | 512-458-5751
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK HIMMEL
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Credential |
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Telephone | 512-458-5707
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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 | 112821
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License Number State | TX
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