Healthcare Provider Details

I. General information

NPI: 1528260478
Provider Name (Legal Business Name): DIAMANTINA OLIVARES DBA GENESIS ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W EXPRESSWAY 83
PALMVIEW TX
78572-8755
US

IV. Provider business mailing address

2820 W EXPRESSWAY 83
PALMVIEW TX
78572-8755
US

V. Phone/Fax

Practice location:
  • Phone: 956-583-6967
  • Fax: 956-583-0484
Mailing address:
  • Phone: 956-583-6967
  • Fax: 956-583-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number119209
License Number StateTX

VIII. Authorized Official

Name: DIAMANTINA OLIVAREZ
Title or Position: OWNER
Credential:
Phone: 956-583-6967