Provider Demographics
NPI:1649517525
Name:MA ASSISTED LIVING
Entity type:Organization
Organization Name:MA ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-709-0247
Mailing Address - Street 1:185 COUNTY ROAD 679
Mailing Address - Street 2:
Mailing Address - City:NATALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78059
Mailing Address - Country:US
Mailing Address - Phone:830-709-0247
Mailing Address - Fax:
Practice Address - Street 1:185 COUNTY ROAD 679
Practice Address - Street 2:
Practice Address - City:NATALIA
Practice Address - State:TX
Practice Address - Zip Code:78059
Practice Address - Country:US
Practice Address - Phone:830-709-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134399310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility