Provider Demographics
NPI:1518218106
Name:BILTMORE ASSISTED LIVING
Entity Type:Organization
Organization Name:BILTMORE ASSISTED LIVING
Other - Org Name:MARIO SAN ROMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN ROMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:956-571-7465
Mailing Address - Street 1:700 E JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1127
Mailing Address - Country:US
Mailing Address - Phone:956-682-5659
Mailing Address - Fax:956-682-5659
Practice Address - Street 1:700 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1127
Practice Address - Country:US
Practice Address - Phone:956-682-5659
Practice Address - Fax:956-682-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133637310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility