Healthcare Provider Details

I. General information

NPI: 1467939801
Provider Name (Legal Business Name): DB ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 WHIRL AWAY DR
EL PASO TX
79936-7836
US

IV. Provider business mailing address

1209 WHIRL AWAY DR
EL PASO TX
79936-7836
US

V. Phone/Fax

Practice location:
  • Phone: 915-244-4966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL BUSTILLOS
Title or Position: PRESIDENT
Credential:
Phone: 915-227-0137