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General NPI Number Information
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NPI Number | 1518395631
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Entity Type | Organization
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Legal Business Name | VIDA NUEVA ADULT DAY CARE
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 409 W ZAVALA ST
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City | CRYSTAL CITY
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State | TX
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Zip | 78839-3241
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Country | US
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Telephone | 830-854-2001
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Fax | 830-854-2150
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Provider Business Mailing Address
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Address Line | 409 W ZAVALA ST
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City | CRYSTAL CITY
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State | TX
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Zip | 78839-3241
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Country | US
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Telephone | 830-854-2001
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Fax | 830-854-2150
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Authorized Official
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Title or Position | FACILITY MANAGER
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Name | ESPERANZA RUIZ
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Credential |
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Telephone | 830-694-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 139178
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | TX
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