Provider Demographics
NPI:1093723967
Name:CARTWHEEL GONZALES REAL ESTATE PARTNERSHIP LTD
Entity Type:Organization
Organization Name:CARTWHEEL GONZALES REAL ESTATE PARTNERSHIP LTD
Other - Org Name:CARTWHEEL LODGE OF GONZALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:830-672-2887
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:1800 CARTWHEEL DR
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629
Mailing Address - Country:US
Mailing Address - Phone:830-672-2887
Mailing Address - Fax:830-672-8039
Practice Address - Street 1:1800 CARTWHEEL DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629
Practice Address - Country:US
Practice Address - Phone:830-672-2887
Practice Address - Fax:830-672-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4965Medicaid
TX4965Medicaid