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General NPI Number Information
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NPI Number | 1871822296
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Entity Type | Organization
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Legal Business Name | EL ORO DEL PUEBLO SERVICE INC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 508 S STANDARD AVE
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City | SAN JUAN
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State | TX
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Zip | 78589-2443
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Country | US
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Telephone | 956-782-1000
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Fax | 956-782-1080
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Provider Business Mailing Address
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Address Line | P.O. BOX 267
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City | WESLAC0
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State | TX
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Zip | 78599
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Country | US
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Telephone | 956-968-1271
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Fax | 956-973-9788
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. BLANCA E GONZALEZ
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Credential | MSW AP
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Telephone | 956-968-1271
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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 | 115767
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 117281
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 117622
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License Number State | TX
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