Provider Demographics
NPI:1588125868
Name:CECILIA TERRES ETERNAL YOUTH HOME 2
Entity type:Organization
Organization Name:CECILIA TERRES ETERNAL YOUTH HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-921-6752
Mailing Address - Street 1:11651 CLEAR LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4382
Mailing Address - Country:US
Mailing Address - Phone:915-921-6752
Mailing Address - Fax:915-633-1994
Practice Address - Street 1:11651 CLEAR LAKE WAY
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4382
Practice Address - Country:US
Practice Address - Phone:915-921-6752
Practice Address - Fax:915-633-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility