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NPI Code Detail

MEDICARE: ELDORADO TEXAS COMMUNITY SERVICE CENTER

MEDICARE: ELDORADO TEXAS COMMUNITY SERVICE CENTER
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2261QM2800XMethadone Clinic1000057TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11000057OTHERTXSTATE NTP LICENSE

General Provider Information

NPI Number : 1699086371
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELDORADO TEXAS COMMUNITY SERVICE CENTER
Provider Business Mailing Address
First Line : 954 E MADISON ST
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78520-5950
Country : US
Telephone Number : 661-254-6630
Fax Number : 661-254-6644
Provider Business Practice Location Address
First Line : 954 E MADISON ST
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78520-5950
Country : US
Telephone Number : 661-254-6630
Fax Number : 661-254-6644
Authorized Official
Title or Position : DIRECTOR OF ADMINISTRATION
Name : MR. PRAMESH PRAKASH SHARMA
Credential :
Telephone Number : 661-313-5503
Provider Enumeration Date : 06/28/2010
Last Update Date : 08/30/2022

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Directions to “ELDORADO TEXAS COMMUNITY SERVICE CENTER ” Practice Location

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