# REGENCY NURSING CENTER PARTNERS OF PORT LAVACA, LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PORT LAVACA NURSING AND REHABILITATION CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710941075
- **Authorized official:** MR. HEBER S. LACERDA (PRESIDENT/CEO)
- **Authorized official phone:** (361) 576-0694

## Contact information

- **Practice address:** 524 VILLAGE RD, PORT LAVACA, TX 77979-2380
- **Practice address phone:** (361) 552-3741
- **Practice address fax:** (361) 552-5808
- **Mailing address:** 524 VILLAGE RD, PORT LAVACA, TX 77979-2380
- **Mailing address phone:** (361) 552-3741
- **Mailing address fax:** (361) 552-5808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 113221 | TX | — |
| 314000000X | Skilled Nursing Facility | 455999 | TX | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 4142560001 | TX | — |

## Other

- **Enumeration date:** 04/13/2006
- **Last updated:** 07/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001001779 | — | TX |
| 05 | — | 142997902 | — | TX |
| 05 | — | 142997903 | — | TX |
| 05 | — | 425903 | — | TX |
| 01 | — | HH044S | BCBS BLUELINK | TX |