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General NPI Number Information
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NPI Number | 1659583912
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Entity Type | Organization
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Legal Business Name | MADELINE C FLORES
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 06/15/2008
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Provider Practice Location Address
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Address Line | 32016 JAY BIRD LN
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City | BULVERDE
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State | TX
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Zip | 78163-4635
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Country | US
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Telephone | 830-980-9713
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Fax | 830-980-9713
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Provider Business Mailing Address
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Address Line | 32016 JAY BIRD LN
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City | BULVERDE
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State | TX
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Zip | 78163-4635
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Country | US
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Telephone | 830-980-9713
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Fax | 830-980-9713
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Authorized Official
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Title or Position | OWNER
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Name | MS. MADELINE C FLORES
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Credential |
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Telephone | 830-980-9713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 118881
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License Number State | TX
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