Provider Demographics
NPI:1285763367
Name:ANDREWS SENIOR ACTIVITY CENTER INC
Entity type:Organization
Organization Name:ANDREWS SENIOR ACTIVITY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-523-5911
Mailing Address - Street 1:310 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-6214
Mailing Address - Country:US
Mailing Address - Phone:432-523-5911
Mailing Address - Fax:432-523-4991
Practice Address - Street 1:310 W BROADWAY
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-6214
Practice Address - Country:US
Practice Address - Phone:432-523-5911
Practice Address - Fax:432-523-4991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREWS SENIOR ACTIVITY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000185400OtherDADS CONTRACT
TX001012866OtherDADS CONTRACT