Provider Demographics
NPI:1851416267
Name:GWENS PLACE INC
Entity Type:Organization
Organization Name:GWENS PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENNETTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-286-1383
Mailing Address - Street 1:12023 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-3313
Mailing Address - Country:US
Mailing Address - Phone:972-286-1383
Mailing Address - Fax:
Practice Address - Street 1:12023 BISHOP DR
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-3313
Practice Address - Country:US
Practice Address - Phone:972-286-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119508310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility