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General NPI Number Information
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NPI Number | 1730317322
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Entity Type | Organization
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Legal Business Name | MAVERICK ADULT DAY CARE L.L.C.
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 3147 MEGAN ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-5891
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Country | US
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Telephone | 830-757-0966
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Fax | 830-757-0976
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Provider Business Mailing Address
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Address Line | 3147 MEGAN ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-5891
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Country | US
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Telephone | 830-757-0966
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Fax | 830-757-0976
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Authorized Official
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Title or Position | ADMIN
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Name | MR. RAPHAEL SANTANA
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Credential | R.N., BNS
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Telephone | 830-757-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 009852
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License Number State | TX
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