Healthcare Provider Details

I. General information

NPI: 1417941303
Provider Name (Legal Business Name): SOUTHWEST LTC CUERO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL DR
CUERO TX
77954-6400
US

IV. Provider business mailing address

17760 PRESTON RD SUITE 310
DALLAS TX
75252-5663
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-3421
  • Fax: 361-275-8640
Mailing address:
  • Phone: 469-916-6100
  • Fax: 469-916-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number004919
License Number StateTX

VIII. Authorized Official

Name: ERIN L KRESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 469-916-6100