MEDICARE: CRUZ PERSONAL CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	000599	TX

General Provider Information

NPI Number	:	1821253030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUZ PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	730 COUNTY ROAD 664
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4685
Country	:	US
Telephone Number	:	830-665-4801
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 COUNTY ROAD 664
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4685
Country	:	US
Telephone Number	:	830-665-4801
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA CRUZ RODRIGUEZ
Credential	:
Telephone Number	:	830-665-4801

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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Directions to “CRUZ PERSONAL CARE HOME ” Practice Location

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