Provider Demographics
NPI:1396394557
Name:NL MARQUEZ ENTERPRISE INC.
Entity Type:Organization
Organization Name:NL MARQUEZ ENTERPRISE INC.
Other - Org Name:SU CASA ADULT FOSTER HOME #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:915-208-3163
Mailing Address - Street 1:12462 PASEO DE ARCO CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5669
Mailing Address - Country:US
Mailing Address - Phone:915-208-3163
Mailing Address - Fax:915-503-5825
Practice Address - Street 1:12462 PASEO DE ARCO CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5669
Practice Address - Country:US
Practice Address - Phone:915-208-3163
Practice Address - Fax:915-503-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual DisabilitiesGroup - Multi-Specialty
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical DisabilitiesGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803380597OtherSECRETARY OF STATE
TX225232OtherBOARD OF NURSING