Provider Demographics
NPI:1598822751
Name:AFFECTIONATE ARMS
Entity Type:Organization
Organization Name:AFFECTIONATE ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-578-9067
Mailing Address - Street 1:3802 JOHN STOCKBUAER
Mailing Address - Street 2:3802 JOHN STOCKBAUEDR
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:361-578-9067
Mailing Address - Fax:361-578-9088
Practice Address - Street 1:3802 JOHN STOCKBAUER
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-578-9067
Practice Address - Fax:361-578-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000324200Medicaid