Healthcare Provider Details

I. General information

NPI: 1356518195
Provider Name (Legal Business Name): SU CASA ADULT DAY CARE II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E JUAREZ
PHARR TX
78577
US

IV. Provider business mailing address

318 W RAIL ROAD
WESLACO TX
78596
US

V. Phone/Fax

Practice location:
  • Phone: 956-702-3870
  • Fax: 956-702-3875
Mailing address:
  • Phone: 956-702-3870
  • Fax: 956-702-3875

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: MARIA ALICIA MORENO
Title or Position: OWNER
Credential: OWNER
Phone: 956-969-3656