Provider Demographics
NPI:1063172674
Name:RUN REAL CARE FACILITY LLC
Entity type:Organization
Organization Name:RUN REAL CARE FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIDIER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNEZERWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-518-1102
Mailing Address - Street 1:6822 LIBERTY STONE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1377
Mailing Address - Country:US
Mailing Address - Phone:207-518-1102
Mailing Address - Fax:
Practice Address - Street 1:6822 LIBERTY STONE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1377
Practice Address - Country:US
Practice Address - Phone:207-518-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty