Provider Demographics
NPI:1558831347
Name:STATE OF TEXAS VETERANS LAND BOARD
Entity Type:Organization
Organization Name:STATE OF TEXAS VETERANS LAND BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-463-4909
Mailing Address - Street 1:PO BOX 12873
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78711-2873
Mailing Address - Country:US
Mailing Address - Phone:512-463-4909
Mailing Address - Fax:
Practice Address - Street 1:14041 COTTINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048
Practice Address - Country:US
Practice Address - Phone:512-463-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF TEXAS VETERANS LAND BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility