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General NPI Number Information
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NPI Number | 1225188592
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Entity Type | Organization
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Legal Business Name | COASTAL BEND ADULT DAY CARE, INC.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 102 BROADWAY
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City | FULTON
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State | TX
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Zip | 78358
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Country | US
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Telephone | 361-729-5433
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Fax | 361-729-6612
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Provider Business Mailing Address
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Address Line | PO BOX 1147
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City | FULTON
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State | TX
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Zip | 78358-1147
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Country | US
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Telephone | 361-729-5433
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Fax | 361-729-6612
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JOANNA SAIN
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Credential | RN
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Telephone | 361-229-3705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 117082
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License Number State | TX
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