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1710941075

NPI Code Detail

MEDICARE: REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD

MEDICARE: REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD

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	113221	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	4142560001	TX
3	314000000X	Skilled Nursing Facility	455999	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	HH044S	OTHER	TX	BCBS BLUELINK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710941075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD

Provider Business Mailing Address
First Line	:	524 VILLAGE RD
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2380
Country	:	US
Telephone Number	:	361-552-3741
Fax Number	:	361-552-5808

Provider Business Practice Location Address
First Line	:	524 VILLAGE RD
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2380
Country	:	US
Telephone Number	:	361-552-3741
Fax Number	:	361-552-5808

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. HEBER S. LACERDA
Credential	:
Telephone Number	:	361-576-0694

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/01/2009

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Directions to “REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD ” Practice Location

Language	Start Address	Practice Location

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