MEDICARE: MUNDO DE AMOR 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		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326390949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUNDO DE AMOR ADULT DAY CARE, LLC.

Provider Business Mailing Address
First Line	:	4606 E SOUTHCROSS BLVD
Second Line	:	102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-4911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 E SOUTHCROSS BLVD # 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-4911
Country	:	US
Telephone Number	:	210-648-0238
Fax Number	:	844-274-1062

Authorized Official
Title or Position	:	OWNER/ADMIN
Name	:	MRS. EVELYN DIAZ
Credential	:
Telephone Number	:	210-896-8139

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	03/17/2020

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