Provider Demographics
NPI:1134320187
Name:LA HACIENDA ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:LA HACIENDA ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-727-2169
Mailing Address - Street 1:1616 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4464
Mailing Address - Country:US
Mailing Address - Phone:956-727-2169
Mailing Address - Fax:
Practice Address - Street 1:420 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8415
Practice Address - Country:US
Practice Address - Phone:956-727-2169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118254251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based