Organization
ST. JOSEPH MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAROLD COTTRELL (EXECUTIVE DIRECTOR/ADMINISTRATOR)
(979) 821-7330
Entity
Organization
Contact information
Practice address
2333 MANOR DRIVE, BRYAN, TX 77802-1907
(979) 821-7330
(979) 821-7301
Mailing address
2333 MANOR DRIVE, BRYAN, TX 77802-1907
(979) 821-7330
(979) 821-7301
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
114596
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001000504
—
TX
Enumeration date
08/14/2006
Last updated
04/09/2008
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