1316901929 NPI number — CUERO MANOR, INC.

Table of content: (NPI 1316901929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316901929 NPI number — CUERO MANOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUERO MANOR, 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:
CUERO NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
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:
1316901929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 E BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUERO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77954-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-275-9133
Provider Business Mailing Address Fax Number:
361-275-9136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 E BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUERO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77954-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-275-9133
Provider Business Practice Location Address Fax Number:
361-275-9136
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LACERDA
Authorized Official First Name:
HEBER
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
361-576-0694

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  112015 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 675110 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 1059270001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 531401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH043S . This is a "BCBS BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000531401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010810202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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