Provider Demographics
NPI:1679782981
Name:LA SALLE CO. ELDERLY NUTRIITION PROGRAM
Entity type:Organization
Organization Name:LA SALLE CO. ELDERLY NUTRIITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-879-2804
Mailing Address - Street 1:119 S FRONT
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-2261
Mailing Address - Country:US
Mailing Address - Phone:830-879-2804
Mailing Address - Fax:830-879-4233
Practice Address - Street 1:119 S FRONT
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-2261
Practice Address - Country:US
Practice Address - Phone:830-879-2804
Practice Address - Fax:830-879-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals