Healthcare Provider Details

I. General information

NPI: 1346375730
Provider Name (Legal Business Name): ROSALINDA BENNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CORPUS CHRISTI ST SUITE 1
LAREDO TX
78043
US

IV. Provider business mailing address

2100 CORPUS CHRISTI ST SUITE 1
LAREDO TX
78043
US

V. Phone/Fax

Practice location:
  • Phone: 956-791-9093
  • Fax: 956-791-9010
Mailing address:
  • Phone: 956-791-9093
  • Fax: 956-791-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number118882
License Number StateTX

VIII. Authorized Official

Name: MS. ROSALINDA BENNETT
Title or Position: OWNER
Credential: LVN
Phone: 956-791-9093