Healthcare Provider Details

I. General information

NPI: 1538282538
Provider Name (Legal Business Name): LYTLE NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15366 OAK ST.
LYTLE TX
78052-0486
US

IV. Provider business mailing address

PO BOX 486
LYTLE TX
78052-0486
US

V. Phone/Fax

Practice location:
  • Phone: 830-772-3661
  • Fax: 830-772-4810
Mailing address:
  • Phone: 830-772-3661
  • Fax: 830-772-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number04780
License Number StateTX

VIII. Authorized Official

Name: GLENDA M METZGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 830-772-3661