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General NPI Number Information
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NPI Number | 1710060454
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Entity Type | Organization
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Legal Business Name | COMANCHE COUNTY ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 ALAMO
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City | COMANCHE
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State | TX
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Zip | 76442-2063
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Country | US
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Telephone | 325-356-9303
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Fax | 325-356-3875
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Provider Business Mailing Address
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Address Line | 100 ALAMO
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City | COMANCHE
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State | TX
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Zip | 76442-2063
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Country | US
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Telephone | 325-356-9303
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Fax | 325-356-3875
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CELIA KAY MONTGOMERY
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Credential |
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Telephone | 325-356-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 116881
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License Number State | TX
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