Provider Demographics
NPI:1477850378
Name:LOST PINES PERSONAL CARE
Entity Type:Organization
Organization Name:LOST PINES PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINNIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HERDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-988-9999
Mailing Address - Street 1:1093 GOTIER TRACE RD
Mailing Address - Street 2:
Mailing Address - City:PAIGE
Mailing Address - State:TX
Mailing Address - Zip Code:78659-4403
Mailing Address - Country:US
Mailing Address - Phone:512-581-8027
Mailing Address - Fax:
Practice Address - Street 1:1093 GOTIER TRACE RD
Practice Address - Street 2:
Practice Address - City:PAIGE
Practice Address - State:TX
Practice Address - Zip Code:78659-4403
Practice Address - Country:US
Practice Address - Phone:512-581-8027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility