Healthcare Provider Details

I. General information

NPI: 1265083406
Provider Name (Legal Business Name): OAK CREEK ESTATE ALF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 OAK CREEK ESTATES RD
POTEET TX
78065-4019
US

IV. Provider business mailing address

309 OAK CREEK ESTATES RD
POTEET TX
78065-4019
US

V. Phone/Fax

Practice location:
  • Phone: 830-276-4248
  • Fax:
Mailing address:
  • Phone: 830-276-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BENNY JOE LOPEZ
Title or Position: OWNER
Credential:
Phone: 210-419-5670