Provider Demographics
NPI:1265655781
Name:MISSION ADULT & SENIOR CARE CENTER PA.
Entity Type:Organization
Organization Name:MISSION ADULT & SENIOR CARE CENTER PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-2770
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0017
Mailing Address - Country:US
Mailing Address - Phone:956-581-2770
Mailing Address - Fax:956-581-7811
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 4
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-3072
Practice Address - Country:US
Practice Address - Phone:956-581-2770
Practice Address - Fax:956-581-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155641701Medicaid
TX00373RMedicare PIN