MEDICARE: MAUDIE GARRETT

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	311ZA0620X	Adult Care Home Facility		TX

General Provider Information

NPI Number	:	1356484869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAUDIE GARRETT

Provider Business Mailing Address
First Line	:	445 MT. PLEASANT ST.
Second Line	:
City	:	PITTSBURGH
State	:	TX
Zip	:	75686
Country	:	US
Telephone Number	:	903-856-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 MOUNT PLEASANT ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1121
Country	:	US
Telephone Number	:	903-856-3504
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAUDIE GARRETT
Credential	:
Telephone Number	:	903-856-3504

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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