Provider Demographics
NPI:1174724710
Name:VILLA QUILT OF CORPUS SOUTH, LP
Entity type:Organization
Organization Name:VILLA QUILT OF CORPUS SOUTH, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:505-797-8735
Mailing Address - Street 1:4834 YORKTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5364
Mailing Address - Country:US
Mailing Address - Phone:361-991-3252
Mailing Address - Fax:361-242-9764
Practice Address - Street 1:4834 YORKTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5364
Practice Address - Country:US
Practice Address - Phone:361-991-3252
Practice Address - Fax:361-242-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000317310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility