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General NPI Number Information
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NPI Number | 1669977179
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Entity Type | Organization
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Legal Business Name | AUDERE HEALTH SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 211 EL RIO DR
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City | LAKEWAY
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State | TX
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Zip | 78734-4512
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Country | US
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Telephone | 737-228-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 211 EL RIO DR
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City | LAKEWAY
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State | TX
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Zip | 78734-4512
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Country | US
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Telephone | 737-228-5769
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL OLOF EVANS
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Credential | OTR, MA
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Telephone | 737-228-5769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 113733
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License Number State | TX
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