Individual
JUDY LYNN BROYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1088 N WILLOW OAK RD, GLADEWATER, TX 75647-7811
(903) 714-3099
Mailing address
1088 N WILLOW OAK RD, GLADEWATER, TX 75647-7811
(903) 714-3099
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316559321
—
TX
Enumeration date
06/01/2020
Last updated
12/14/2020
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