Healthcare Provider Details

I. General information

NPI: 1649619446
Provider Name (Legal Business Name): DOMINION SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 MCPHERSON RD STE H
LAREDO TX
78041-6215
US

IV. Provider business mailing address

6419 MCPHERSON RD STE H
LAREDO TX
78041-6215
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-3979
  • Fax: 956-568-4014
Mailing address:
  • Phone: 956-568-3979
  • Fax: 956-568-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number136846
License Number StateTX

VIII. Authorized Official

Name: MARIA ELENA HINOJOSA
Title or Position: OWNER
Credential:
Phone: 956-568-3979