Provider Demographics
NPI:1962984484
Name:AFFECTIONATE ARMS
Entity type:Organization
Organization Name:AFFECTIONATE ARMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-578-9067
Mailing Address - Street 1:3802 JOHN STOCKBAUER DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2448
Mailing Address - Country:US
Mailing Address - Phone:361-578-9067
Mailing Address - Fax:361-578-9088
Practice Address - Street 1:3802 JOHN STOCKBAUER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2448
Practice Address - Country:US
Practice Address - Phone:361-578-9067
Practice Address - Fax:361-578-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145607261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145607Medicaid
TX000324200Medicaid