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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