Provider Demographics
NPI:1285644138
Name:OAK CREEK PERSONAL CARE HOME
Entity Type:Organization
Organization Name:OAK CREEK PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELOY
Authorized Official - Middle Name:WINTERS
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-276-4248
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:POTEET
Mailing Address - State:TX
Mailing Address - Zip Code:78065-1479
Mailing Address - Country:US
Mailing Address - Phone:830-276-4248
Mailing Address - Fax:830-276-4248
Practice Address - Street 1:299 OAK CREEK ESTATES
Practice Address - Street 2:
Practice Address - City:POTEET
Practice Address - State:TX
Practice Address - Zip Code:78065
Practice Address - Country:US
Practice Address - Phone:830-276-4248
Practice Address - Fax:830-276-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-04-13
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2012-04-13
Provider Licenses
StateLicense IDTaxonomies
TX000519310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility