Provider Demographics
NPI:1114552346
Name:RGV KIDZ PLACE, LLC
Entity Type:Organization
Organization Name:RGV KIDZ PLACE, LLC
Other - Org Name:RGV KIDZ PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARMONA ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-231-0173
Mailing Address - Street 1:2722 FOUNTAIN PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8030
Mailing Address - Country:US
Mailing Address - Phone:956-231-0173
Mailing Address - Fax:956-290-8010
Practice Address - Street 1:2722 FOUNTAIN PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8030
Practice Address - Country:US
Practice Address - Phone:956-231-0179
Practice Address - Fax:956-290-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care