Healthcare Provider Details

I. General information

NPI: 1780942367
Provider Name (Legal Business Name): PASO DEL NORTE CHILDREN'S DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E SCHUSTER AVE
EL PASO TX
79902-4659
US

IV. Provider business mailing address

1101 E SCHUSTER AVE
EL PASO TX
79902-4659
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-8484
  • Fax: 915-496-0751
Mailing address:
  • Phone: 915-544-8484
  • Fax: 915-496-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number51103
License Number StateTX

VIII. Authorized Official

Name: JAIME BARCELEAU
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 915-544-8484