Provider Demographics
NPI:1639204183
Name:REEVES COUNTY HOME DELIVERED MEALS PROGRAM
Entity Type:Organization
Organization Name:REEVES COUNTY HOME DELIVERED MEALS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REEVES COUNTY JUDGE
Authorized Official - Prefix:MR
Authorized Official - First Name:WON
Authorized Official - Middle Name:JOO
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-445-5418
Mailing Address - Street 1:700 W DAGGETT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-6900
Mailing Address - Country:US
Mailing Address - Phone:432-447-0333
Mailing Address - Fax:432-447-0373
Practice Address - Street 1:700 W DAGGETT ST
Practice Address - Street 2:SUITE F
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-6900
Practice Address - Country:US
Practice Address - Phone:432-447-0333
Practice Address - Fax:432-447-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332U00000XOtherHOME DELIVERED MEALS CCAD
TX332U00000XOtherHOME DELIVERED MEALS CBA