Provider Demographics
NPI:1437158714
Name:GONZALES HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:GONZALES HEALTHCARE SYSTEMS
Other - Org Name:MEMORIAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:830-672-9508
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-7581
Mailing Address - Fax:830-672-2401
Practice Address - Street 1:1314 N SARAH DEWITT DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3314
Practice Address - Country:US
Practice Address - Phone:830-672-7581
Practice Address - Fax:830-672-2401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GONZALES HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023701801Medicaid
TX8600Medicaid
TX6483Medicaid