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General NPI Number Information
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NPI Number | 1942698360
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Entity Type | Organization
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Legal Business Name | MI SEGUNDA CASA ADULT DAY CARE
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1605 E HILLSIDE RD STE 2
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City | LAREDO
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State | TX
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Zip | 78041-3460
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Country | US
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Telephone | 956-608-2053
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Fax | 956-608-3623
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Provider Business Mailing Address
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Address Line | 1605 E HILLSIDE RD STE 2
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City | LAREDO
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State | TX
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Zip | 78041-3460
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Country | US
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Telephone | 956-608-2053
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Fax | 956-608-3623
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Authorized Official
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Title or Position | DIRECTOR/ACTIVITIES COORDINATTOR
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Name | MR. JUAN R VAZQUEZ
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Credential |
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Telephone | 956-251-2253
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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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