Provider Demographics
NPI:1215541230
Name:ANGELES ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:ANGELES ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LIZET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-566-0879
Mailing Address - Street 1:4100 W 3 MILE RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-6177
Mailing Address - Country:US
Mailing Address - Phone:956-583-2233
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3 MILE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-6177
Practice Address - Country:US
Practice Address - Phone:956-583-2233
Practice Address - Fax:956-583-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care