Healthcare Provider Details

I. General information

NPI: 1811185077
Provider Name (Legal Business Name): GLORY DAYS ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 RESACA SHORES BLVD
SAN BENITO TX
78586-5734
US

IV. Provider business mailing address

2004 W JEFFERSON AVE STE. D
HARLINGEN TX
78550-5212
US

V. Phone/Fax

Practice location:
  • Phone: 956-241-1229
  • Fax:
Mailing address:
  • Phone: 956-412-8038
  • Fax: 956-412-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number119174
License Number StateTX

VIII. Authorized Official

Name: MR. JOSE L. GARZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-412-8038