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General NPI Number Information
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NPI Number | 1366396038
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Entity Type | Organization
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Legal Business Name | CIBOLO PARK HEALTHCARE LLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 111 PARKS VILLAGE DR
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City | ODESSA
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State | TX
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Zip | 79765-8987
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Country | US
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Telephone | 432-563-5707
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Fax | 949-540-3007
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Provider Business Mailing Address
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Address Line | 111 PARKS VILLAGE DR
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City | ODESSA
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State | TX
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Zip | 79765-8987
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Country | US
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Telephone | 432-563-5707
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Fax | 949-540-3007
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Authorized Official
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Title or Position | SECRETARY
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Name | SOON BURNAM
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Credential |
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Telephone | 949-540-1249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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