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General NPI Number Information
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NPI Number | 1619918489
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Entity Type | Organization
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Legal Business Name | SAN JUAN NURSING HOME, INC.
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 300 N NEBRASKA AVE
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City | SAN JUAN
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State | TX
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Zip | 78589-3040
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Country | US
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Telephone | 956-787-1771
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Fax | 956-787-8091
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Provider Business Mailing Address
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Address Line | 300 N. NEBRASKA AVE.
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City | SAN JUAN
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State | TX
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Zip | 78589
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Country | US
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Telephone | 956-787-1771
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Fax | 956-787-8091
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELOISA FERNANDEZ
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Credential |
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Telephone | 956-787-1771
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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 | 144386
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License Number State | TX
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