Healthcare Provider Details

I. General information

NPI: 1669651865
Provider Name (Legal Business Name): MI PUEBLO ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HORIZON BLVD SUITE # E
SOCORRO TX
79927-4691
US

IV. Provider business mailing address

681 HORIZON BLVD SUITE # E
SOCORRO TX
79927-4691
US

V. Phone/Fax

Practice location:
  • Phone: 915-860-8690
  • Fax: 915-860-7210
Mailing address:
  • Phone: 915-860-8690
  • Fax: 915-860-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number121409
License Number StateTX

VIII. Authorized Official

Name: MRS. YOLANDA RODRIGUEZ
Title or Position: ADMINISTRATOR
Credential: MSN,RN
Phone: 915-740-2782