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General NPI Number Information
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NPI Number | 1689879363
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Entity Type | Organization
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Legal Business Name | MEDINA COUNTY
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 808A HARPER
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City | HONDO
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State | TX
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Zip | 78861-2000
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Country | US
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Telephone | 830-741-6160
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Fax | 830-741-6164
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Provider Business Mailing Address
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Address Line | 808A HARPER
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City | HONDO
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State | TX
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Zip | 78861-2000
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Country | US
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Telephone | 830-741-6160
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Fax | 830-741-6164
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Authorized Official
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Title or Position | MANAGER, NUTRITION CENTER
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Name | MRS. MICHELE THACKER III
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Credential |
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Telephone | 830-741-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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