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General NPI Number Information
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NPI Number | 1497813885
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Entity Type | Organization
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Legal Business Name | RUNNINGWATER DRAW CARE CENTER
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1200 AVE I
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City | OLTON
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State | TX
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Zip | 79064-0767
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Country | US
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Telephone | 806-285-3356
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Fax | 806-285-2506
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Provider Business Mailing Address
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Address Line | PO BOX 767
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City | OLTON
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State | TX
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Zip | 79064-0767
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Country | US
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Telephone | 806-285-3356
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Fax | 806-285-2506
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Authorized Official
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Title or Position | MANAGER
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Name | ROLINDA SUE MATHEWS
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Credential |
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Telephone | 806-285-3356
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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 | 11097
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License Number State | TX
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