Provider Demographics
NPI:1316901929
Name:CUERO MANOR, INC.
Entity type:Organization
Organization Name:CUERO MANOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:1310 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2133
Mailing Address - Country:US
Mailing Address - Phone:361-275-9133
Mailing Address - Fax:361-275-9136
Practice Address - Street 1:1310 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2133
Practice Address - Country:US
Practice Address - Phone:361-275-9133
Practice Address - Fax:361-275-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059270001332B00000X
TX112015313M00000X
TX675110314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531401Medicaid
TXHH043SOtherBCBS BLUE LINK
TX000531401Medicaid
TX010810202Medicaid
TX752438840OtherCUERO PTRS, LTD EIN
TXHH043SOtherBCBS BLUE LINK
TX531401Medicaid
TX742640807OtherCNRC, INC. EIN