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General NPI Number Information
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NPI Number | 1417504945
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Entity Type | Organization
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Legal Business Name | WILLACY HEALTHCARE INC
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 211 CEDAR DR
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City | PORTLAND
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State | TX
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Zip | 78374-2900
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Country | US
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Telephone | 361-777-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 18843 REDLAND RD
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City | SAN ANTONIO
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State | TX
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Zip | 78259-3562
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGEMENT COMPANY
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Name | MELANIE GAGLIARDO
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Credential |
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Telephone | 210-385-5416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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