Healthcare Provider Details

I. General information

NPI: 1144662990
Provider Name (Legal Business Name): GONZALES HEALTHCARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N MAGNOLIA AVE
LULING TX
78648-1604
US

IV. Provider business mailing address

1105 N MAGNOLIA AVE
LULING TX
78648-1604
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-5606
  • Fax:
Mailing address:
  • Phone: 830-875-5606
  • Fax: 830-672-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON ANZALDUA
Title or Position: CEO
Credential:
Phone: 830-672-7581