Healthcare Provider Details

I. General information

NPI: 1013239086
Provider Name (Legal Business Name): IDOLINA'S ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38615 W MILE 7
LA JOYA TX
78560
US

IV. Provider business mailing address

7003 BUENA VISTA DR
PALMVIEW TX
78572-1842
US

V. Phone/Fax

Practice location:
  • Phone: 956-624-0082
  • Fax: 956-424-1223
Mailing address:
  • Phone: 956-624-0082
  • Fax: 956-424-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAURA A HERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 956-624-0082