Provider Demographics
NPI:1942347026
Name:LOPEZ ASSISTED LIVING HOMES INC.
Entity Type:Organization
Organization Name:LOPEZ ASSISTED LIVING HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WHITNEY
Authorized Official - Last Name:MLCAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-884-4697
Mailing Address - Street 1:3706 SHERRIL BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3857
Mailing Address - Country:US
Mailing Address - Phone:210-884-4697
Mailing Address - Fax:210-436-9106
Practice Address - Street 1:3706 SHERRIL BROOK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3857
Practice Address - Country:US
Practice Address - Phone:210-884-4697
Practice Address - Fax:210-436-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030366310400000X
TX100358310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001061Medicaid
TX001003599Medicaid