Provider Demographics
NPI:1124148457
Name:THE MADERA CORP
Entity type:Organization
Organization Name:THE MADERA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRES SEC TREASURY
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEANE
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED VOCATIONAL
Authorized Official - Phone:903-843-7601
Mailing Address - Street 1:1704 NORTH BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644
Mailing Address - Country:US
Mailing Address - Phone:903-843-7601
Mailing Address - Fax:903-843-4871
Practice Address - Street 1:1704 NORTH BRADFORD ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644
Practice Address - Country:US
Practice Address - Phone:903-843-7601
Practice Address - Fax:903-843-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113958310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility