Provider Demographics
NPI:1538157243
Name:FLATONIA OAK MANOR L.P.
Entity type:Organization
Organization Name:FLATONIA OAK MANOR L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-865-3571
Mailing Address - Street 1:624 N CONVERSE ST
Mailing Address - Street 2:
Mailing Address - City:FLATONIA
Mailing Address - State:TX
Mailing Address - Zip Code:78941-2535
Mailing Address - Country:US
Mailing Address - Phone:361-865-3571
Mailing Address - Fax:361-865-2445
Practice Address - Street 1:624 N CONVERSE ST
Practice Address - Street 2:
Practice Address - City:FLATONIA
Practice Address - State:TX
Practice Address - Zip Code:78941-2535
Practice Address - Country:US
Practice Address - Phone:361-865-3571
Practice Address - Fax:361-865-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112303314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675445Medicare ID - Type UnspecifiedPROVIDER NUMBER