Provider Demographics
NPI:1083928634
Name:CLARA SELENE PENA
Entity Type:Organization
Organization Name:CLARA SELENE PENA
Other - Org Name:ELCIELO ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-414-9948
Mailing Address - Street 1:401 BUSINESS 83 STE D
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3088
Mailing Address - Country:US
Mailing Address - Phone:956-464-2386
Mailing Address - Fax:
Practice Address - Street 1:401 BUSINESS 83 STE D
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3088
Practice Address - Country:US
Practice Address - Phone:956-464-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care