101 Farm To Market LLC
Substance Abuse Rehabilitation Facility in Georgetown, TX. Organization (NPI-2).
NPI number1780428441
StatusActive
Last updated in NPPESSep 23, 2025
Details
- NPI
- 1780428441
- Entity type
- Organization (NPI-2)
- Legal business name
- 101 Farm To Market LLC
- Organization subpart
- No
- Enumeration date
- Jun 19, 2024
- Certification date
- Sep 23, 2025
- Last updated
- Sep 23, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | – | – | Yes |
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – |
Other names
- Vered At San Gabriel (Doing Business As)
Practice location
101 Fm 971Georgetown, TX 78626-4546
Phone 816-547-9248
Mailing address
101 Fm 971Georgetown, TX 78626-4546
Authorized official
Heather Cooley
Coo
5128393895
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