MEDICARE: VILLA DORADA DAY CENTER, INC.

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	261QA0600X	Adult Day Care Clinic/Center	133535	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122419	OTHER	TX	TEXAS DEPARTMENT OF AGING

General Provider Information

NPI Number	:	1851575682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA DORADA DAY CENTER, INC.

Provider Business Mailing Address
First Line	:	3849 W. HWY. 83
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582
Country	:	US
Telephone Number	:	956-487-5752
Fax Number	:	956-487-5709

Provider Business Practice Location Address
First Line	:	3849 W US HIGHWAY 83
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582
Country	:	US
Telephone Number	:	956-487-5752
Fax Number	:	956-487-5709

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARY ELIZABETH GARZA
Credential	:
Telephone Number	:	956-487-5752

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	08/30/2018

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