Provider Demographics
NPI:1386771988
Name:RETAMA MANOR
Entity type:Organization
Organization Name:RETAMA MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-8502
Mailing Address - Street 1:721 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6617
Mailing Address - Country:US
Mailing Address - Phone:956-968-8502
Mailing Address - Fax:956-968-0286
Practice Address - Street 1:721 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6617
Practice Address - Country:US
Practice Address - Phone:956-968-8502
Practice Address - Fax:956-968-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility