Provider Demographics
NPI:1245487925
Name:LEGEND OAKS-SOUTH SAN ANTONIO, LLC
Entity type:Organization
Organization Name:LEGEND OAKS-SOUTH SAN ANTONIO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-927-0800
Mailing Address - Street 1:2003 W HUTCHINS PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1368
Mailing Address - Country:US
Mailing Address - Phone:210-927-0800
Mailing Address - Fax:210-927-0806
Practice Address - Street 1:2003 W HUTCHINS PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1368
Practice Address - Country:US
Practice Address - Phone:210-927-0800
Practice Address - Fax:210-927-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676113Medicare PIN