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General NPI Number Information
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NPI Number | 1689885097
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Entity Type | Organization
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Legal Business Name | LA MANSION ADULT DAY CARE CENTER, INC.
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 611 LINCOLN AVE
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City | ROBSTOWN
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State | TX
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Zip | 78380-3711
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Country | US
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Telephone | 361-387-7474
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Fax | 361-387-7811
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Provider Business Mailing Address
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Address Line | 210 N UPSHAW BLVD
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City | ROBSTOWN
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State | TX
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Zip | 78380-3141
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Country | US
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Telephone | 361-443-6363
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Fax | 361-387-7811
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Authorized Official
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Title or Position | DIRECTOR
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Name | DIANA M GONZALEZ
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Credential |
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Telephone | 361-387-7474
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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 | 116024
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License Number State | TX
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