Provider Demographics
NPI:1871635938
Name:RODOLFO R. LEDESMA
Entity Type:Organization
Organization Name:RODOLFO R. LEDESMA
Other - Org Name:LEDESMA PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-432-2087
Mailing Address - Street 1:1809 ALLENDE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237
Mailing Address - Country:US
Mailing Address - Phone:210-432-2087
Mailing Address - Fax:210-438-1177
Practice Address - Street 1:1809 ALLENDE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237
Practice Address - Country:US
Practice Address - Phone:210-432-2087
Practice Address - Fax:210-438-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114094310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility