Healthcare Provider Details

I. General information

NPI: 1679782981
Provider Name (Legal Business Name): LA SALLE CO. ELDERLY NUTRIITION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S FRONT
COTULLA TX
78014-2261
US

IV. Provider business mailing address

119 S FRONT
COTULLA TX
78014-2261
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2804
  • Fax: 830-879-4233
Mailing address:
  • Phone: 830-879-2804
  • Fax: 830-879-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateTX

VIII. Authorized Official

Name: GRACIELA ORTIZ
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 830-879-2804