Provider Demographics
NPI:1720895071
Name:ELISA M DURDA
Entity type:Organization
Organization Name:ELISA M DURDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADULT FOSTERCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DURDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-452-8804
Mailing Address - Street 1:147 CROESUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4416
Mailing Address - Country:US
Mailing Address - Phone:210-452-8804
Mailing Address - Fax:210-979-9251
Practice Address - Street 1:147 CROESUS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4416
Practice Address - Country:US
Practice Address - Phone:210-452-8804
Practice Address - Fax:210-979-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home