Healthcare Provider Details

I. General information

NPI: 1811350721
Provider Name (Legal Business Name): MORNING DOVE ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W EXPY 83 STE 4
PHARR TX
78577-6504
US

IV. Provider business mailing address

1210 W EXPY 83 STE 4
PHARR TX
78577-6504
US

V. Phone/Fax

Practice location:
  • Phone: 956-782-5525
  • Fax: 956-752-5500
Mailing address:
  • Phone: 956-782-5525
  • Fax: 956-752-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number142877
License Number StateTX

VIII. Authorized Official

Name: GERALD WAYNE WOODMAN
Title or Position: OWNER/ADMINISTRATOR
Credential: LVN
Phone: 956-782-5525