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General NPI Number Information
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NPI Number | 1639204183
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Entity Type | Organization
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Legal Business Name | REEVES COUNTY HOME DELIVERED MEALS PROGRAM
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 700 W DAGGETT ST SUITE F
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City | PECOS
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State | TX
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Zip | 79772-6900
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Country | US
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Telephone | 432-447-0333
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Fax | 432-447-0373
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Provider Business Mailing Address
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Address Line | 700 W DAGGETT ST SUITE F
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City | PECOS
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State | TX
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Zip | 79772-6900
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Country | US
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Telephone | 432-447-0333
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Fax | 432-447-0373
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Authorized Official
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Title or Position | REEVES COUNTY JUDGE
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Name | MR. WON JOO BANG
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Credential | M.D.
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Telephone | 432-445-5418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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