Healthcare Provider Details

I. General information

NPI: 1114290046
Provider Name (Legal Business Name): CASA DE NUESTRA GENTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N MEADOW AVE
LAREDO TX
78040-5350
US

IV. Provider business mailing address

1212 N MEADOW AVE
LAREDO TX
78040-5350
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-6493
  • Fax: 956-712-0016
Mailing address:
  • Phone: 956-753-6493
  • Fax: 956-712-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARALYSIA BENAVIDES
Title or Position: DIRECTOR
Credential:
Phone: 956-753-6493