Provider Demographics
NPI:1194761676
Name:MADISONVILLE MANAGMENT
Entity type:Organization
Organization Name:MADISONVILLE MANAGMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMIN.
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-348-2735
Mailing Address - Street 1:411 E COLLARD ST
Mailing Address - Street 2:P.O. BOX 40
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-3306
Mailing Address - Country:US
Mailing Address - Phone:936-348-2735
Mailing Address - Fax:936-348-6727
Practice Address - Street 1:411 E COLLARD ST
Practice Address - Street 2:411 EAST COLLARD ST.
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-3306
Practice Address - Country:US
Practice Address - Phone:936-348-2735
Practice Address - Fax:936-348-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherSTATE TAX ID #
TX=========OtherSTATE TAX ID #