Provider Demographics
NPI:1487880704
Name:LONGHORN VILLAGE
Entity type:Organization
Organization Name:LONGHORN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-507-4699
Mailing Address - Street 1:12501 LONGHORN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1267
Mailing Address - Country:US
Mailing Address - Phone:512-266-5600
Mailing Address - Fax:512-266-5601
Practice Address - Street 1:12001 LONGHORN PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1204
Practice Address - Country:US
Practice Address - Phone:512-266-5600
Practice Address - Fax:512-266-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137833314000000X
310400000X
TX103910314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676266Medicare Oscar/Certification