Healthcare Provider Details

I. General information

NPI: 1285644138
Provider Name (Legal Business Name): OAK CREEK PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date: 06/03/2008
Reactivation Date: 04/13/2012

III. Provider practice location address

299 OAK CREEK ESTATES
POTEET TX
78065
US

IV. Provider business mailing address

PO BOX 1479
POTEET TX
78065-1479
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number000519
License Number StateTX

VIII. Authorized Official

Name: MR. ELOY WINTERS DUNCAN
Title or Position: OWNER
Credential:
Phone: 830-276-4248