Organization
CENTURY-EBONY LAKE-GEAC,LLC
Active
Other names
Ebony Lake Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE M RYAN RN,MS (OWNER'S REPRESENTATIVE)
(952) 837-0818
Entity
Organization
Contact information
Practice address
1001 CENTRAL BLVD, BROWNSVILLE, TX 78520-7533
(956) 541-0917
(956) 541-2860
Mailing address
1001 CENTRAL BLVD, BROWNSVILLE, TX 78520-7533
(956) 541-0917
(956) 541-2860
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
112530
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005259
—
TX
Enumeration date
09/29/2005
Last updated
08/22/2020
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