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General NPI Number Information
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NPI Number | 1003232729
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Entity Type | Organization
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Legal Business Name | CONGREGATION OF THE DAUGHTERS OF MARY MOTHER OF MERCY
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 237 SOUTH GREEN ROAD
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-867-0993
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Fax | 956-424-3586
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Provider Business Mailing Address
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Address Line | 237 SOUTH GREEN ROAD
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City | PALMVIEW
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-867-0993
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Fax | 956-424-3586
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELIZABETH NKECHINYERE IRUKA
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Credential | MBA,BSN
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Telephone | 956-867-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 014983
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License Number State | TX
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