Provider Demographics
NPI:1669693545
Name:ALFREDO GONZALEZ TEXAS STATE VETERANS HOME
Entity type:Organization
Organization Name:ALFREDO GONZALEZ TEXAS STATE VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-682-4224
Mailing Address - Street 1:301 E YUMA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1388
Mailing Address - Country:US
Mailing Address - Phone:956-682-4224
Mailing Address - Fax:956-682-4668
Practice Address - Street 1:301 E YUMA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1388
Practice Address - Country:US
Practice Address - Phone:956-682-4224
Practice Address - Fax:956-682-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628365314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility