Healthcare Provider Details

I. General information

NPI: 1164628731
Provider Name (Legal Business Name): LA ESPERANZA ADULT ACTIVITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MOORE ST
BEEVILLE TX
78102-6928
US

IV. Provider business mailing address

302 MOORE ST
BEEVILLE TX
78102-6928
US

V. Phone/Fax

Practice location:
  • Phone: 361-362-4999
  • Fax: 361-362-4994
Mailing address:
  • Phone: 361-362-4999
  • Fax: 361-362-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number050755
License Number StateTX

VIII. Authorized Official

Name: MRS. ROSIE COFFEEN
Title or Position: OWNER
Credential:
Phone: 361-362-4999