MEDICARE: TEXAS SENIOR & DISABLED DAY CARE, L.L.C.

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	129696	VA

General Provider Information

NPI Number	:	1689995037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS SENIOR & DISABLED DAY CARE, L.L.C.

Provider Business Mailing Address
First Line	:	1223 N LEE TREVINO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-1548
Country	:	US
Telephone Number	:	915-592-3100
Fax Number	:	915-592-3110

Provider Business Practice Location Address
First Line	:	1223 N. LEE TREVINO DR.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907
Country	:	US
Telephone Number	:	915-592-3100
Fax Number	:	915-592-3110

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILLIE RAUL PADILLA JR.
Credential	:	B.S.
Telephone Number	:	915-592-3100

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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Directions to “TEXAS SENIOR & DISABLED DAY CARE, L.L.C. ” Practice Location

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