Pecan Valley SCC LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PECAN VALLEY SCC LLC

Practice address

3838 E Southcross Blvd
San Antonio, TX 78222-3556

Phone

(210) 581-6994

Fax

(210) 572-6994

NPI assigned

May 22, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Beal

Title

Chief Executive Officer

Phone

(214) 252-7600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SCC at Pecan Valley Rehabilitation and Healthcare Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1396124392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N PEARL ST STE 1050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017495",
            "telephone_number": "214-252-7600",
            "fax_number": "214-252-7599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 E SOUTHCROSS BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782223556",
            "telephone_number": "210-581-6994",
            "fax_number": "210-572-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY SCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-252-7600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENDOR ID/FACILITY ID",
            "identifier": "5574/104259",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001027034",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCC at Pecan Valley Rehabilitation and Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCC at Pecan Valley Rehabilitation and Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Lynn Pease, M.D.
• Dan C Peavy, D.D.S., M.S.D.
• Anthony G Peay
• Julia Peay
• Pecan Valley Healthcare LLC
• Alisha Marie Pecero
• Marc Daniel Pecha, M.D.
• Elizabeth Marie Peche, FNP
• Rosauro Peciller Jr., D.P.T.
• Brandon Lee Peck, PTA

• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.