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General NPI Number Information
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NPI Number | 1659685089
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Entity Type | Organization
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Legal Business Name | LOPEZ HOMES MCG LLC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 3125 ELK RIVER TRL
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City | BULVERDE
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State | TX
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Zip | 78163-2227
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Country | US
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Telephone | 210-365-0532
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Fax |
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Provider Business Mailing Address
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Address Line | 118 WALLACE ST
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City | SAN ANTONIO
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State | TX
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Zip | 78237-3112
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Country | US
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Telephone | 210-438-8750
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Fax | 830-438-5539
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Authorized Official
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Title or Position | MANAGER
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Name | MR. TOM G LOPEZ JR.
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Credential |
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Telephone | 210-365-0532
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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 | 103075
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License Number State | TX
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