Healthcare Provider Details

I. General information

NPI: 1972785566
Provider Name (Legal Business Name): MIZPAH ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 S CLOSNER BLVD
EDINBURG TX
78539-6208
US

IV. Provider business mailing address

2311 S CLOSNER BLVD
EDINBURG TX
78539-6208
US

V. Phone/Fax

Practice location:
  • Phone: 956-387-0388
  • Fax: 956-387-0210
Mailing address:
  • Phone: 956-387-0388
  • Fax: 956-387-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number12647
License Number StateTX

VIII. Authorized Official

Name: MAIDA PEREZ
Title or Position: OWNER
Credential:
Phone: 956-387-0388