Organization
LAKEWOOD SENIOR LIVING OF ALTA VISTA LLC
Active
Other names
Lakewood Senior Living of Alta Vista
Organization subpart
No
Provider details
NPI number
Authorized official
MS. APRIL M PUCCETTI (ADMINISTRATOR)
(205) 320-7507
Entity
Organization
Contact information
Practice address
616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
(210) 735-9233
(210) 735-0164
Mailing address
616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
(210) 735-9233
(210) 735-0164
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
115822
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001013791
—
TX
Enumeration date
09/20/2006
Last updated
04/28/2010
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