Provider Demographics
NPI:1336135185
Name:LA HACIENDA NURSING HOME, INC.
Entity Type:Organization
Organization Name:LA HACIENDA NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-279-3860
Mailing Address - Street 1:4410 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:TX
Mailing Address - Zip Code:78384-4516
Mailing Address - Country:US
Mailing Address - Phone:361-279-3860
Mailing Address - Fax:361-279-3687
Practice Address - Street 1:4410 HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:TX
Practice Address - Zip Code:78384-4516
Practice Address - Country:US
Practice Address - Phone:361-279-3860
Practice Address - Fax:361-279-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112118313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4578Medicaid