Healthcare Provider Details

I. General information

NPI: 1003999731
Provider Name (Legal Business Name): KEYWEST ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 FOX PL
EAGLE PASS TX
78852-4479
US

IV. Provider business mailing address

2508 FOX PL
EAGLE PASS TX
78852-4479
US

V. Phone/Fax

Practice location:
  • Phone: 830-757-3253
  • Fax: 830-757-4330
Mailing address:
  • Phone: 830-757-3253
  • Fax: 830-757-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number117200
License Number StateTX

VIII. Authorized Official

Name: HECTOR HUGO VIELMA
Title or Position: DIRECTOR
Credential:
Phone: 830-757-3253