Provider Demographics
NPI:1548449051
Name:BLANCA A. GONZALEZ
Entity type:Organization
Organization Name:BLANCA A. GONZALEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACTIVITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-527-3153
Mailing Address - Street 1:911 N SIGRID AVE
Mailing Address - Street 2:
Mailing Address - City:HEBBRONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78361-2337
Mailing Address - Country:US
Mailing Address - Phone:956-220-6140
Mailing Address - Fax:
Practice Address - Street 1:1007 W VIGGIE ST
Practice Address - Street 2:
Practice Address - City:HEBBRONVILLE
Practice Address - State:TX
Practice Address - Zip Code:78361-2363
Practice Address - Country:US
Practice Address - Phone:361-527-3153
Practice Address - Fax:361-527-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121520311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home