Organization
ADVANCED LIVING TECHNOLOGIES INC
Active
Other names
COUNTRY CAREPLEX
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL GRAY (PRESIDENT)
(512) 345-0700
Entity
Organization
Contact information
Practice address
1181 N WILLIAMSON ST, GIDDINGS, TX 78942-1213
(979) 542-3611
(979) 542-1365
Mailing address
10415 MORADO CIR, SUITE 3 120, AUSTIN, TX 78759-5696
(512) 345-0700
(888) 368-3534
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
117933
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000477503
—
TX
Enumeration date
04/13/2007
Last updated
11/02/2012
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