Healthcare Provider Details

I. General information

NPI: 1427352822
Provider Name (Legal Business Name): CONCHITA'S ADULT DAY CARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E RINGGOLD ST
RIO GRANDE CITY TX
78582-3413
US

IV. Provider business mailing address

1003 E RINGGOLD ST
RIO GRANDE CITY TX
78582-3413
US

V. Phone/Fax

Practice location:
  • Phone: 956-566-9939
  • Fax:
Mailing address:
  • Phone: 956-566-9939
  • 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: MR. EVAN L BUTCHER
Title or Position: MANAGER
Credential:
Phone: 956-566-9939