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General NPI Number Information
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NPI Number | 1326683475
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Entity Type | Organization
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Legal Business Name | COUNTRY LIVING ADULT FOSTER CARE
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 175 COUNTY ROAD 6721
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City | NATALIA
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State | TX
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Zip | 78059-2123
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Country | US
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Telephone | 830-444-1395
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Fax |
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Provider Business Mailing Address
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Address Line | 175 COUNTY ROAD 6721
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City | NATALIA
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State | TX
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Zip | 78059-2123
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Country | US
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Telephone | 830-444-1395
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDA CHARLOTTE LEE
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Credential |
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Telephone | 830-444-1395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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