Provider Demographics
NPI:1154462497
Name:LONGORIA PERSONAL CARE HOME, INC
Entity Type:Organization
Organization Name:LONGORIA PERSONAL CARE HOME, INC
Other - Org Name:LONGORIA PERSONAL CARE HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-622-9808
Mailing Address - Street 1:16740 IH 35 S UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ATASCOSA
Mailing Address - State:TX
Mailing Address - Zip Code:78002-5773
Mailing Address - Country:US
Mailing Address - Phone:210-622-9808
Mailing Address - Fax:210-622-3731
Practice Address - Street 1:16740 IH 35 S UNIT 2
Practice Address - Street 2:
Practice Address - City:ATASCOSA
Practice Address - State:TX
Practice Address - Zip Code:78002-5773
Practice Address - Country:US
Practice Address - Phone:210-622-9808
Practice Address - Fax:210-622-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189363104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness