Healthcare Provider Details

I. General information

NPI: 1629500897
Provider Name (Legal Business Name): LITTLE BIT OF SUNSHINE ADULT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E SAN PATRICIO AVE
MATHIS TX
78368
US

IV. Provider business mailing address

108 E SAN PATRICIO AVE
MATHIS TX
78368
US

V. Phone/Fax

Practice location:
  • Phone: 361-547-9797
  • Fax: 361-547-9777
Mailing address:
  • Phone: 361-547-9797
  • Fax: 361-547-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICARDO LEAL JR.
Title or Position: OWNER
Credential:
Phone: 361-547-9797