Healthcare Provider Details

I. General information

NPI: 1427445808
Provider Name (Legal Business Name): BETESDA ILG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HOOKS AVE STE B
DONNA TX
78537-3341
US

IV. Provider business mailing address

1205 HOOKS AVE STE B
DONNA TX
78537-3341
US

V. Phone/Fax

Practice location:
  • Phone: 956-461-6601
  • Fax: 956-461-6602
Mailing address:
  • Phone: 956-461-6601
  • Fax: 956-461-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELVIA A SANCHEZ
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 956-461-6601