MEDICARE: FAMILY IN FAITH ADULT DAY CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1083897151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY IN FAITH ADULT DAY CARE, LLC

Provider Business Mailing Address
First Line	:	881 S SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-3062
Country	:	US
Telephone Number	:	956-399-7812
Fax Number	:	956-388-2785

Provider Business Practice Location Address
First Line	:	881 S SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-3062
Country	:	US
Telephone Number	:	956-399-7812
Fax Number	:	956-388-2785

Authorized Official
Title or Position	:	OWNER
Name	:	SAN JUANITA EUZEBIO
Credential	:	R.N., B.S.N.
Telephone Number	:	956-399-7812

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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