MEDICARE: MARTIN DUNCAN PERSONAL CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	118599	TX

General Provider Information

NPI Number	:	1104986371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN DUNCAN PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	266 W COUNTY ROAD 5719
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4028
Country	:	US
Telephone Number	:	830-709-3544
Fax Number	:	830-709-3544

Provider Business Practice Location Address
First Line	:	266 W COUNTY ROAD 5719
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4028
Country	:	US
Telephone Number	:	830-709-3544
Fax Number	:	830-709-3544

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARTIN DUNCAN
Credential	:
Telephone Number	:	830-709-3544

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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