Healthcare Provider Details

I. General information

NPI: 1477784577
Provider Name (Legal Business Name): CROSSROADS AULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4574 E US HIGHWAY 83 STE B
RIO GRANDE CITY TX
78582-7019
US

IV. Provider business mailing address

202 N. FLORES
RIO GRANDE CITY TX
78582
US

V. Phone/Fax

Practice location:
  • Phone: 956-487-3700
  • Fax: 956-487-3722
Mailing address:
  • Phone: 956-487-3700
  • Fax: 956-487-3700

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. JUAN R. BARRERA
Title or Position: DIRECTOR
Credential:
Phone: 956-487-3700