Provider Demographics
NPI:1164628731
Name:LA ESPERANZA ADULT ACTIVITY CENTER
Entity Type:Organization
Organization Name:LA ESPERANZA ADULT ACTIVITY CENTER
Other - Org Name:D.B.A ROSIE COFFEEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-362-4999
Mailing Address - Street 1:302 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-6928
Mailing Address - Country:US
Mailing Address - Phone:361-362-4999
Mailing Address - Fax:361-362-4994
Practice Address - Street 1:302 MOORE ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-6928
Practice Address - Country:US
Practice Address - Phone:361-362-4999
Practice Address - Fax:361-362-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050755261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001651OtherDADS