Basic Information
| Provider Information | |||||||||
| NPI: | 1083855621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING ARTS COMMUNITY HEALTH CENTER OF BLANCO AND CANYON LAKE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 S US HIGHWAY 281 | ||||||||
| Address2: | |||||||||
| City: | BLANCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786065205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308330510 | ||||||||
| FaxNumber: | 8308334307 | ||||||||
| Practice Location | |||||||||
| Address1: | 4520 S US HIGHWAY 281 | ||||||||
| Address2: | |||||||||
| City: | BLANCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786065205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308330510 | ||||||||
| FaxNumber: | 8308334307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2009 | ||||||||
| LastUpdateDate: | 12/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | WIDICK | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8308330510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.