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General NPI Number Information
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NPI Number | 1154462497
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Entity Type | Organization
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Legal Business Name | LONGORIA PERSONAL CARE HOME, INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 16740 IH 35 S UNIT 2
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City | ATASCOSA
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State | TX
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Zip | 78002-5773
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Country | US
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Telephone | 210-622-9808
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Fax | 210-622-3731
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Provider Business Mailing Address
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Address Line | 16740 IH 35 S UNIT 2
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City | ATASCOSA
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State | TX
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Zip | 78002-5773
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Country | US
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Telephone | 210-622-9808
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Fax | 210-622-3731
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Authorized Official
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Title or Position | OWNER
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Name | MS. MAGDALENA LONGORIA
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Credential |
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Telephone | 210-622-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 118936
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License Number State | TX
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