Provider Demographics
NPI:1164748216
Name:ELDORADO TEXAS COMMUNITY SERVICE
Entity Type:Organization
Organization Name:ELDORADO TEXAS COMMUNITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAMESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-6630
Mailing Address - Street 1:5510 N CAGE BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1812
Mailing Address - Country:US
Mailing Address - Phone:661-254-6630
Mailing Address - Fax:661-254-6644
Practice Address - Street 1:5510 N CAGE BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1812
Practice Address - Country:US
Practice Address - Phone:661-254-6630
Practice Address - Fax:661-254-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX-10240-MOtherSAMHSA