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General NPI Number Information
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NPI Number | 1528260478
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Entity Type | Organization
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Legal Business Name | DIAMANTINA OLIVARES DBA GENESIS ADULT DAY CARE
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2820 W EXPRESSWAY 83
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City | PALMVIEW
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State | TX
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Zip | 78572-8755
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Country | US
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Telephone | 956-583-6967
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Fax | 956-583-0484
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Provider Business Mailing Address
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Address Line | 2820 W EXPRESSWAY 83
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City | PALMVIEW
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State | TX
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Zip | 78572-8755
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Country | US
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Telephone | 956-583-6967
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Fax | 956-583-0484
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Authorized Official
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Title or Position | OWNER
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Name | DIAMANTINA OLIVAREZ
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Credential |
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Telephone | 956-583-6967
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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 | 119209
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License Number State | TX
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