Provider Demographics
NPI:1659583912
Name:MADELINE C FLORES
Entity Type:Organization
Organization Name:MADELINE C FLORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-980-9713
Mailing Address - Street 1:32016 JAY BIRD LN
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4635
Mailing Address - Country:US
Mailing Address - Phone:830-980-9713
Mailing Address - Fax:830-980-9713
Practice Address - Street 1:32016 JAY BIRD LN
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4635
Practice Address - Country:US
Practice Address - Phone:830-980-9713
Practice Address - Fax:830-980-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118881311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF50016200Medicaid