Organization
AVANTI-AYUSH,LLC
Active
Other names
VINTAGE ESTATES
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUBBATH MALLIK M.D. (MANAGER OF LLC)
(432) 336-0700
Entity
Organization
Contact information
Practice address
237 WEST 21ST STREED, FORT STOCKTON, TX 79735
(432) 336-6922
Mailing address
2071 N MAIN ST, FORT STOCKTON, TX 79735-3041
(432) 336-0700
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
TX
Other
Enumeration date
11/25/2009
Last updated
11/25/2009
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