Healthcare Provider Details

I. General information

NPI: 1154648459
Provider Name (Legal Business Name): COUNTY OF LA SALLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MARS DRIVE
COTULLA TX
78014
US

IV. Provider business mailing address

369 MARS DRIVE
COTULLA TX
78014
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-4430
  • Fax:
Mailing address:
  • Phone: 830-879-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LEODORO MARTINEZ III
Title or Position: COUNTY JUDGE
Credential:
Phone: 830-879-4430