Provider Demographics
NPI:1689879363
Name:MEDINA COUNTY
Entity Type:Organization
Organization Name:MEDINA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, NUTRITION CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:830-741-6160
Mailing Address - Street 1:808A HARPER
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-2000
Mailing Address - Country:US
Mailing Address - Phone:830-741-6160
Mailing Address - Fax:830-741-6164
Practice Address - Street 1:808A HARPER
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-2000
Practice Address - Country:US
Practice Address - Phone:830-741-6160
Practice Address - Fax:830-741-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty