Healthcare Provider Details

I. General information

NPI: 1629197033
Provider Name (Legal Business Name): SANTA CRUZ DAY CARE FOR ADULTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 PALM DR
ELSA TX
78543-2070
US

IV. Provider business mailing address

PO BOX 2070
ELSA TX
78543-2070
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-6229
  • Fax:
Mailing address:
  • Phone: 956-255-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number000331200
License Number StateTX

VIII. Authorized Official

Name: MR. EZEQUIEL OMAR SALAZAR
Title or Position: OWNER
Credential:
Phone: 956-376-0450