Organization
GOLD STAR ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY LYNN TIDWELL (MANAGER)
(903) 567-2762
Entity
Organization
Contact information
Practice address
503 W HIGHWAY 243, CANTON, TX 75103-2113
(903) 567-2762
(903) 567-2237
Mailing address
PO BOX 1090, CANTON, TX 75103-7090
(903) 567-2762
(309) 567-2237
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
030299
TX
Other
Enumeration date
04/17/2007
Last updated
08/22/2020
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