Provider Demographics
NPI:1386832350
Name:REAGAN COUNTY HOME DELIVERED MEALS
Entity Type:Organization
Organization Name:REAGAN COUNTY HOME DELIVERED MEALS
Other - Org Name:TRAILBLAZERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-884-2376
Mailing Address - Street 1:1205 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76932-3400
Mailing Address - Country:US
Mailing Address - Phone:325-884-2376
Mailing Address - Fax:325-884-2014
Practice Address - Street 1:1205 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:TX
Practice Address - Zip Code:76932-3400
Practice Address - Country:US
Practice Address - Phone:325-884-2376
Practice Address - Fax:325-884-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001012855332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals