Provider Demographics
NPI:1659685089
Name:LOPEZ HOMES MCG LLC
Entity Type:Organization
Organization Name:LOPEZ HOMES MCG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-365-0532
Mailing Address - Street 1:118 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3112
Mailing Address - Country:US
Mailing Address - Phone:210-438-8750
Mailing Address - Fax:830-438-5539
Practice Address - Street 1:3125 ELK RIVER TRL
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2227
Practice Address - Country:US
Practice Address - Phone:210-365-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103075310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility