# BURLESON ST. JOSEPH MANOR

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184627093
- **Authorized official:** MR. HAROLD COTTRELL LNFA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (979) 567-0920

## Contact information

- **Practice address:** 1022 PRESIDENTIAL CORRIDOR EAST, CALDWELL, TX 77836-4611
- **Practice address phone:** (979) 567-0920
- **Practice address fax:** (979) 567-4811
- **Mailing address:** 1022 PRESIDENTIAL CORRIDOR EAST, CALDWELL, TX 77836-4611
- **Mailing address phone:** (979) 567-0920
- **Mailing address fax:** (979) 567-4811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 107880 | TX | Yes |

## Other

- **Enumeration date:** 05/24/2005
- **Last updated:** 01/25/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001000513 | — | TX |