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General NPI Number Information
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NPI Number | 1841052693
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Entity Type | Organization
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Legal Business Name | OUR LADY RESIDENTIAL ASSISTED LIVING
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 209 W HACKBERRY AVE
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City | MCALLEN
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State | TX
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Zip | 78501-2550
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Country | US
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Telephone | 956-336-7906
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Fax |
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Provider Business Mailing Address
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Address Line | 6208 N 16TH ST MCALLEN, TX
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City | MCALLEN
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State | TX
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Zip | 78504
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Country | US
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Telephone | 956-207-9425
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MARIE CLAUDE CHARLES
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Credential | RN
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Telephone | 956-207-9425
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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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