Healthcare Provider Details

I. General information

NPI: 1922013440
Provider Name (Legal Business Name): INEZ BROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W AUSTIN ST
LULING TX
78648-1741
US

IV. Provider business mailing address

PO BOX 312
LULING TX
78648-0312
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-5628
  • Fax: 830-875-5302
Mailing address:
  • Phone: 830-875-5628
  • Fax: 830-875-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number116418
License Number StateTX

VIII. Authorized Official

Name: MRS. EVELYN HANSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 830-875-5628