Organization
AMANDA GOMEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GOMEZ (OWNER)
(936) 205-6628
Entity
Organization
Contact information
Practice address
113 TYLER AVE, ALTO, TX 75925-3306
(936) 205-6628
Mailing address
PO BOX 206, ALTO, TX 75925-0206
(936) 205-6628
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004322
—
TX
Enumeration date
09/16/2014
Last updated
09/16/2014
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