Healthcare Provider Details

I. General information

NPI: 1609693449
Provider Name (Legal Business Name): BABY BOOMERS ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N CAROLINA DR STE D
EL PASO TX
79915-2771
US

IV. Provider business mailing address

131 ANITA CIR
EL PASO TX
79905-3040
US

V. Phone/Fax

Practice location:
  • Phone: 915-667-9161
  • 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: ROCIO RIOS
Title or Position: OWNER
Credential:
Phone: 915-667-9161