Provider Demographics
NPI:1043207897
Name:CUERO NURSING HOME INC
Entity Type:Organization
Organization Name:CUERO NURSING HOME INC
Other - Org Name:LEGACY LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/MEDICARE
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-622-6300
Mailing Address - Street 1:1010 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2317
Mailing Address - Country:US
Mailing Address - Phone:361-277-6133
Mailing Address - Fax:361-275-6169
Practice Address - Street 1:1010 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2317
Practice Address - Country:US
Practice Address - Phone:361-277-6133
Practice Address - Fax:361-275-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114693313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00113554Medicaid
TX00113554Medicaid