# ST. JOSEPH MANOR

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

## Provider details

- **NPI number:** 1932112554
- **Authorized official:** MR. HAROLD COTTRELL (EXECUTIVE DIRECTOR/ADMINISTRATOR)
- **Authorized official phone:** (979) 821-7330

## Contact information

- **Practice address:** 2333 MANOR DRIVE, BRYAN, TX 77802-1907
- **Practice address phone:** (979) 821-7330
- **Practice address fax:** (979) 821-7301
- **Mailing address:** 2333 MANOR DRIVE, BRYAN, TX 77802-1907
- **Mailing address phone:** (979) 821-7330
- **Mailing address fax:** (979) 821-7301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 114596 | TX | Yes |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 04/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001000504 | — | TX |