Provider Demographics
NPI:1073717088
Name:REAGAN MANOR
Entity Type:Organization
Organization Name:REAGAN MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-643-3888
Mailing Address - Street 1:229 ECR 5718
Mailing Address - Street 2:
Mailing Address - City:NATALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 ECR 5718
Practice Address - Street 2:
Practice Address - City:NATALIA
Practice Address - State:TX
Practice Address - Zip Code:78016
Practice Address - Country:US
Practice Address - Phone:830-709-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120398310400000X, 3104A0625X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances