Provider Demographics
NPI:1073912861
Name:GONZALES COUNTY SENIOR CITIZENS ASSOCIATION, INC
Entity Type:Organization
Organization Name:GONZALES COUNTY SENIOR CITIZENS ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-672-7014
Mailing Address - Street 1:PO BOX 1834
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629
Mailing Address - Country:US
Mailing Address - Phone:830-672-7014
Mailing Address - Fax:830-672-6469
Practice Address - Street 1:818 SEYDLER STREET
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629
Practice Address - Country:US
Practice Address - Phone:830-672-7014
Practice Address - Fax:830-672-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332U00000XSuppliersHome Delivered Meals