Provider Demographics
NPI:1841052693
Name:OUR LADY RESIDENTIAL ASSISTED LIVING
Entity type:Organization
Organization Name:OUR LADY RESIDENTIAL ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-207-9425
Mailing Address - Street 1:6208 N 16TH ST
Mailing Address - Street 2:MCALLEN, TX
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-207-9425
Mailing Address - Fax:
Practice Address - Street 1:209 W HACKBERRY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2550
Practice Address - Country:US
Practice Address - Phone:956-336-7906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility