MEDICARE: SOUTHLAND VILLA CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1093712432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND VILLA CARE CENTER

Provider Business Mailing Address
First Line	:	2222 S 5TH ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-7446
Country	:	US
Telephone Number	:	254-773-1641
Fax Number	:	254-773-3227

Provider Business Practice Location Address
First Line	:	2222 S 5TH ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-7446
Country	:	US
Telephone Number	:	254-773-1641
Fax Number	:	254-773-3227

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DENNIS A HORSCH
Credential	:
Telephone Number	:	254-773-1641

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/22/2020

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