MEDICARE: ST CHARBEL ADULT DAY CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	121506	TX

General Provider Information

NPI Number	:	1124214390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CHARBEL ADULT DAY CARE, LLC

Provider Business Mailing Address
First Line	:	2514 BUDDY OWENS AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5464
Country	:	US
Telephone Number	:	956-687-8819
Fax Number	:	956-687-2218

Provider Business Practice Location Address
First Line	:	2514 BUDDY OWENS AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5464
Country	:	US
Telephone Number	:	956-687-8819
Fax Number	:	956-687-2218

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	RICARDO GARCIA JR.
Credential	:
Telephone Number	:	956-687-8819

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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