Healthcare Provider Details

I. General information

NPI: 1104225465
Provider Name (Legal Business Name): M&M ADULT DAYCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 25TH AVE N
TEXAS CITY TX
77590-5505
US

IV. Provider business mailing address

722 25TH AVE N
TEXAS CITY TX
77590-5505
US

V. Phone/Fax

Practice location:
  • Phone: 409-995-0621
  • Fax:
Mailing address:
  • Phone: 409-995-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number140116
License Number StateTX

VIII. Authorized Official

Name: MRS. CONNIE JEAN SANDERS
Title or Position: OWNER
Credential:
Phone: 409-599-3889