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NPI Code Detail

MEDICARE: PECAN VALLEY HEALTHCARE LLC

MEDICARE: PECAN VALLEY HEALTHCARE 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 Facility129441TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1104259OTHERTXFACILITY ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700111754
Entity Type Code : Organization
Provider Name (Legal Business Name) : PECAN VALLEY HEALTHCARE LLC
Provider Business Mailing Address
First Line : 8000 IH 10 W
Second Line : SUITE 1500
City : SAN ANTONIO
State : TX
Zip : 78230-3802
Country : US
Telephone Number : 210-525-7993
Fax Number : 210-525-7992
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 : 210-525-7993
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : TIMOTHY CRANK
Credential :
Telephone Number : 210-525-7993
Provider Enumeration Date : 10/08/2009
Last Update Date : 07/23/2010

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Directions to “PECAN VALLEY HEALTHCARE LLC ” Practice Location

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