Provider Demographics
NPI: | 1598801680 |
---|---|
Name: | CARE INN OF SEGUIN LLC |
Entity Type: | Organization |
Organization Name: | CARE INN OF SEGUIN LLC |
Other - Org Name: | CARE INN OF SEGUIN |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARTA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MALEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 830-379-7777 |
Mailing Address - Street 1: | 930 RIDGEBROOK RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SPARKS |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21152-9390 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1219 EASTWOOD DR |
Practice Address - Street 2: | |
Practice Address - City: | SEGUIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78155-5133 |
Practice Address - Country: | US |
Practice Address - Phone: | 830-379-7777 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-29 |
Last Update Date: | 2009-01-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 001014928 | Medicaid | |
TX | 001014928 | Medicaid |