Provider Demographics
NPI:1710060454
Name:COMANCHE COUNTY ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:COMANCHE COUNTY ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-356-9303
Mailing Address - Street 1:100 ALAMO
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-2063
Mailing Address - Country:US
Mailing Address - Phone:325-356-9303
Mailing Address - Fax:325-356-3875
Practice Address - Street 1:100 ALAMO
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-2063
Practice Address - Country:US
Practice Address - Phone:325-356-9303
Practice Address - Fax:325-356-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116881251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1014590OtherCBA CONTRACT NUMBER