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General NPI Number Information
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NPI Number | 1386625523
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Entity Type | Organization
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Legal Business Name | LINDA MARIE MOTHERWELL
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Dates
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Enumeration Date | 11/06/2005
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 418 WEST MAIN
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City | NACOGDOCHES
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State | TX
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Zip | 75961-3968
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Country | US
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Telephone | 936-552-1609
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Fax | 936-560-9982
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Provider Business Mailing Address
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Address Line | 418 W MAIN ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4814
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Country | US
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Telephone | 936-552-1609
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Fax | 936-560-9982
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LINDA MARIE MOTHERWELL
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Credential | RN
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Telephone | 936-552-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 009689
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License Number State | TX
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