# SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHBROOKE MANOR NURSING AND REHABILITATION CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285697763
- **Authorized official:** MR. HEBER S LACERDA (PRESIDENT/CEO)
- **Authorized official phone:** (361) 576-0694

## Contact information

- **Practice address:** 1401 W MAIN ST, EDNA, TX 77957-2454
- **Practice address phone:** (361) 782-7614
- **Practice address fax:** (361) 782-5612
- **Mailing address:** 1401 W MAIN ST, EDNA, TX 77957-2454
- **Mailing address phone:** (361) 782-7614
- **Mailing address fax:** (361) 782-5612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 115308 | TX | — |
| 314000000X | Skilled Nursing Facility | 675159 | TX | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1005880001 | TX | — |

## Other

- **Enumeration date:** 04/07/2006
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 530201 | — | TX |
| 01 | — | HH045S | BCBS BLUELINK | TX |