NPIMap

Organization Active NPI

Citizens Medical Center County of Victoria

Doing business as Southbrooke Manor Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Edna, TX
National Provider Identifier
1801217997
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Doing business as
Southbrooke Manor Nursing and Rehabilitation Center
Practice address
1401 W Main St
Edna, TX 77957-2454
Phone
(361) 782-7614
Fax
(833) 217-5345
NPI assigned
Dec 17, 2013
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Authorized official

Name
Mr. Michael Olson
Title
Ceo/Administrator
Phone
(361) 573-9181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1401 W Main St
Edna, TX 77957-2454

Mailing address

2701 Hospital Dr
Victoria, TX 77901-5748
Phone (361) 573-9181

Other names 1

  • SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140410000267 TX Part A Provider - Skilled Nursing Facility 9537139845 Practice locations: Edna, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801217997. Details of each certification follow.

Skilled nursing facility certification: CCN 675159

Legal name
CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Doing business as
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 1, 1993
Last certification
Nov 22, 2024
Beds
120
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Regency Integrated Health Services
Organization structure
OtherNon-profit
Incorporated
in TX
Enrollment address
1401 W Main St
Edna, TX 77957-2454
Nursing home name
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER
Affiliated entity
WELLSENTIAL HEALTH

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Southbrooke Manor Nursing and Rehabilitation CenteCCN 675159 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12084.3 residents per day on average
Chain
Wellsential Health67 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
John W Vaughn12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 36

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
CSV Rhea Management Holdco, LLC Organization, New York, NY LLC, Investment firm, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Russell Marshall Individual Managing Control - Governing BodyVice Chairman Apr 23, 2014
Ben Galvin Individual Managing Control - Governing BodySecretary Jun 16, 2014
Individual Adp of the SNF Jan 1, 2025
Michael R Olson Individual Corporate OfficerCeo Nov 12, 2015
Managing Control - Governing BodyCeo Nov 12, 2015
Molly Breanne Quinn-Frankel Individual Adp of the SNF Jan 1, 2025
Regency IHS Rehab LLC Organization, Baltimore, MD LLC Adp of the SNF Mar 1, 2014
Regency Texas Holdings LLC Organization, Baltimore, MD LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Luis a Guerra Individual Managing Control - Governing BodyChairman Jan 1, 2009
Courtney Korenek Individual Operational/Managerial Control Aug 8, 2023
Adp of the SNF Aug 8, 2023
Patricia Gibson Individual Managing Control - Governing BodyTreasurer Aug 1, 2021
Jack and Nancy Dwyer Workforce Development Center Inc Organization, Baltimore, MD Corporation Indirect Ownership Interest Mar 1, 2014
Reg Operator Holdco LLC Organization, Baltimore, MD LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Barbara B Clapp Individual Managing Control - Governing BodyCeo Jun 1, 2021
Individual Adp of the SNF Jan 1, 2025
Reg HG Opco LLC Organization, Baltimore, MD LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Antonio Carvajal Individual Managing Control - Governing BodyMember May 16, 2024
Individual Adp of the SNF Jan 1, 2025
Reg HG Opco 1, LLC Organization, Baltimore, MD LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Paul B Holm Individual Managing Control - Governing BodyTreasurer Jan 1, 2007
Regency IHS Master Tenant LLC Organization, Baltimore, MD LLC Adp of the SNF Mar 1, 2014
DWD TX Holdings LLC Organization, Baltimore, MD LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2014
Veronica Gonzales Individual Managing Control - Governing BodyMember May 16, 2024
Regency Integrated Health Services LLC Organization, Victoria, TX LLC Operational/Managerial Control Mar 1, 2014
Adp of the SNF Mar 27, 2025
Nicole Kaufman Individual Managing Control - Governing BodyMember Aug 10, 2021
Regency IHS of Southbrooke Manor LLC Organization, Baltimore, MD LLC, Management services company Operational/Managerial Control Mar 1, 2014 100%
Adp of the SNF Mar 27, 2025
Direct Ownership Interest Mar 1, 2014
Daniel S Baird Individual Managing Control - Governing BodyPresident/Chairman Apr 13, 2021
Fariborz Gorouhi Individual Managing Control - Governing BodyMember Jul 1, 2023
1401 West Main Street LLC Organization, Baltimore, MD LLC Adp of the SNF Mar 1, 2014
Regency IHS Clinical Consulting, LLC Organization, Baltimore, MD LLC Adp of the SNF Mar 1, 2014
James F Neumann Individual Managing Control - Governing BodyMember May 31, 2016
Ashlie Ann Thomas Individual Managing Control - Governing BodyMember Jul 1, 2023
Donovan R Dekowski Individual Operational/Managerial Control Mar 1, 2014
Adp of the SNF Mar 1, 2014
Daren a Cortese Individual Managing Control - Governing BodySecretary Aug 10, 2021
Citizens Medical Center County of Victoria Organization, Victoria, TX 5% Or Greater Direct Ownership Interest Mar 1, 2014 100%
Operational/Managerial Control Mar 1, 2014 100%
Adp of the SNF Mar 27, 2025
Elliot J Mandelbaum Individual Managing Control - Governing BodyMember Jan 1, 2025

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Citizens Medical CenterVictoria, TX, CCN 450023 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 1966
Stevens Nursing and Rehabilitation Center of HallettsvilleHallettsville, TX, CCN 675226 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Mar 1, 2014
Mar 1, 2014
Mar 1, 2014
Wharton Nursing and Rehabilitation CenterWharton, TX, CCN 675361 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Mar 1, 2014
Mar 1, 2014
Mar 28, 2025
Port Lavaca Nursing and Rehabilitation CenterPort Lavaca, TX, CCN 455999 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Mar 1, 2014
Mar 1, 2014
Mar 27, 2025
Cuero Nursing and Rehabilitation CenterCuero, TX, CCN 675110 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Mar 1, 2014
Mar 1, 2014
Mar 26, 2025

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 54

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 54

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1801217997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 HOSPITAL DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779015748",
            "telephone_number": "361-573-9181",
            "fax_number": "361-572-5126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W MAIN ST",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779572454",
            "telephone_number": "361-782-7614",
            "fax_number": "833-217-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEDICAL CENTER COUNTY OF VICTORIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-17",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "361-573-9181",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edna, TX

Sources for this page

Verify at the official NPI Registry.