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Organization
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC
Active
Organization
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC
Active
Other names
SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HEBER S LACERDA (PRESIDENT/CEO)
(361) 576-0694
Entity
Organization
Contact information
Practice address
1401 W MAIN ST, EDNA, TX 77957-2454
(361) 782-7614
(361) 782-5612
Mailing address
1401 W MAIN ST, EDNA, TX 77957-2454
(361) 782-7614
(361) 782-5612
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
115308
TX
314000000X
Skilled Nursing Facility
Primary
675159
TX
332B00000X
Durable Medical Equipment & Medical Supplies
1005880001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530201
—
TX
01
—
HH045S
BCBS BLUELINK
TX
Enumeration date
04/07/2006
Last updated
04/20/2008
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