Healthcare Provider Details

I. General information

NPI: 1457550410
Provider Name (Legal Business Name): LA GUADALUPANA ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 CATHLEEN
EAGLE PASS TX
78852-5894
US

IV. Provider business mailing address

338 N. MONROE ST.
EAGLE PASS TX
78852
US

V. Phone/Fax

Practice location:
  • Phone: 830-757-8130
  • Fax: 830-757-8160
Mailing address:
  • Phone: 830-757-8130
  • Fax: 830-757-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICHARD GARZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 830-757-8130