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General NPI Number Information
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NPI Number | 1811178767
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Entity Type | Organization
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Legal Business Name | MI RANCHITO ADULT DAY CARE
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 301-305 N. BROADWAY
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City | ELSA
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State | TX
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Zip | 78543-2011
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Country | US
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Telephone | 956-262-2100
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Fax | 956-262-2179
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Provider Business Mailing Address
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Address Line | PO BOX 2011
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City | ELSA
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State | TX
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Zip | 78543-2011
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Country | US
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Telephone | 956-262-2100
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Fax | 956-262-2179
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DANIEL CAMPOS SR.
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Credential |
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Telephone | 956-262-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 119589
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License Number State | TX
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