Healthcare Provider Details

I. General information

NPI: 1265621304
Provider Name (Legal Business Name): TRINIDAD ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E COLORADO
RIO HONDO TX
78583
US

IV. Provider business mailing address

PO BOX 247
RIO HONDO TX
78583-0247
US

V. Phone/Fax

Practice location:
  • Phone: 956-748-2657
  • Fax:
Mailing address:
  • Phone: 956-748-2657
  • 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: MRS. IRA ROBERTS
Title or Position: DIRECTOR
Credential:
Phone: 956-748-2657