Provider Demographics
NPI:1578892790
Name:NEW CREATION RESIDENTIAL CARE HOMES I & II
Entity Type:Organization
Organization Name:NEW CREATION RESIDENTIAL CARE HOMES I & II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-621-5151
Mailing Address - Street 1:PO BOX 202274
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220
Mailing Address - Country:US
Mailing Address - Phone:210-621-5151
Mailing Address - Fax:210-333-2195
Practice Address - Street 1:406 REGALVIEW ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220
Practice Address - Country:US
Practice Address - Phone:210-621-5151
Practice Address - Fax:210-333-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103726310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility