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General NPI Number Information
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NPI Number | 1679773170
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Entity Type | Organization
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Legal Business Name | APHRODITE LEASING LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 905 EAST HILL STREET
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City | SPUR
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State | TX
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Zip | 79370-2532
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Country | US
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Telephone | 214-912-4539
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Fax |
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Provider Business Mailing Address
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Address Line | 905 EAST HILL STREET
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City | SPUR
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State | TX
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Zip | 79370-2532
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Country | US
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Telephone | 214-912-4539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD DWAIN FOWLER
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Credential |
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Telephone | 214-912-4539
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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 | 4312
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License Number State | TX
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