Healthcare Provider Details

I. General information

NPI: 1982200143
Provider Name (Legal Business Name): DULCE RECUERDOS ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 S. JACKSON ROAD
PHARR TX
78577
US

IV. Provider business mailing address

7608 N 20TH ST
MCALLEN TX
78504-5635
US

V. Phone/Fax

Practice location:
  • Phone: 956-664-1153
  • Fax:
Mailing address:
  • Phone: 956-664-1153
  • Fax:

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: ERIK J MORA
Title or Position: OWNER
Credential:
Phone: 956-664-1153