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NPI Code Detail

MEDICARE: PECAN VALLEY SCC LLC

MEDICARE: PECAN VALLEY SCC LLC
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
1314000000XSkilled Nursing FacilityTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15574/104259OTHERTXVENDOR ID/FACILITY ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396124392
Entity Type Code : Organization
Provider Name (Legal Business Name) : PECAN VALLEY SCC LLC
Provider Business Mailing Address
First Line : 600 N PEARL ST STE 1050
Second Line :
City : DALLAS
State : TX
Zip : 75201-7495
Country : US
Telephone Number : 214-252-7600
Fax Number : 214-252-7599
Provider Business Practice Location Address
First Line : 3838 E SOUTHCROSS BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78222-3556
Country : US
Telephone Number : 210-581-6994
Fax Number : 210-572-6994
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MICHAEL BEAL
Credential :
Telephone Number : 214-252-7600
Provider Enumeration Date : 05/22/2015
Last Update Date : 03/04/2020

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Directions to “PECAN VALLEY SCC LLC ” Practice Location

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