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General NPI Number Information
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NPI Number | 1710805106
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Entity Type | Organization
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Legal Business Name | LA GRAN VIDA LLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 8825 N LOOP DR STE 119
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City | EL PASO
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State | TX
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Zip | 79907-4606
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Country | US
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Telephone | 915-253-9583
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Fax | 915-301-1304
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Provider Business Mailing Address
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Address Line | 8825 N LOOP DR STE 119
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City | EL PASO
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State | TX
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Zip | 79907-4606
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Country | US
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Telephone | 915-253-9583
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Fax | 915-301-1304
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MICHAEL TED WIRZ
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Credential | JD
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Telephone | 915-253-9583
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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 |
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License Number State |
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