Provider Demographics
NPI:1235695057
Name:CASA VERONICA
Entity Type:Organization
Organization Name:CASA VERONICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:L VERNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-373-2490
Mailing Address - Street 1:1601 S TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4227
Mailing Address - Country:US
Mailing Address - Phone:956-373-2490
Mailing Address - Fax:
Practice Address - Street 1:1536 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-4200
Practice Address - Country:US
Practice Address - Phone:956-373-2490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility