Provider Demographics
NPI:1851509632
Name:LENROSE PLACE
Entity Type:Organization
Organization Name:LENROSE PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-363-4171
Mailing Address - Street 1:5395 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-2911
Mailing Address - Country:US
Mailing Address - Phone:409-347-2497
Mailing Address - Fax:409-892-4199
Practice Address - Street 1:5395 ROSE LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-2911
Practice Address - Country:US
Practice Address - Phone:409-347-2497
Practice Address - Fax:409-892-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119564310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility