Healthcare Provider Details

I. General information

NPI: 1023338548
Provider Name (Legal Business Name): ELDORADO TEXAS COMMUNITY SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 N CAGE BLVD SUITE P
PHARR TX
78577-1812
US

IV. Provider business mailing address

PO BOX 1286
BROWNSVILLE TX
78522-1286
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-3544
  • Fax: 956-787-3531
Mailing address:
  • Phone: 956-550-9970
  • Fax: 956-982-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ANN BLANKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-254-6630