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General NPI Number Information
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NPI Number | 1962643296
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Entity Type | Organization
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Legal Business Name | CORDOVA BAY LTD
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 11/22/2014
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Provider Practice Location Address
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Address Line | 10207 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79423-4909
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Country | US
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Telephone | 806-712-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 10207 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79423-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF GENERAL PARTNER
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Name | RONALD E MADISON
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Credential |
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Telephone | 806-712-1110
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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 | 012304
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License Number State | TX
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