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General NPI Number Information
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NPI Number | 1538157243
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Entity Type | Organization
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Legal Business Name | FLATONIA OAK MANOR L.P.
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 624 N CONVERSE ST
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City | FLATONIA
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State | TX
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Zip | 78941-2535
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Country | US
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Telephone | 361-865-3571
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Fax | 361-865-2445
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Provider Business Mailing Address
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Address Line | 624 N CONVERSE ST
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City | FLATONIA
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State | TX
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Zip | 78941-2535
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Country | US
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Telephone | 361-865-3571
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Fax | 361-865-2445
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOE CAMACHO
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Credential |
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Telephone | 361-865-3571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 112303
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License Number State | TX
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