1912273590 NPI number — LOMA PARK ASSISTED LIVING INC

Table of content: (NPI 1912273590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912273590 NPI number — LOMA PARK ASSISTED LIVING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOMA PARK ASSISTED LIVING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912273590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5906 VALLEY COVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78250-3953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-336-9566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1014 NW 38TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-336-9566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VILLARREAL
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
210-336-9566

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  133931 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)