Provider Demographics
NPI:1336475755
Name:EL VAQUERO ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:EL VAQUERO ADULT DAY CARE, LLC
Other - Org Name:EL VAQUERO ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:956-702-9933
Mailing Address - Street 1:1307 W FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2107
Mailing Address - Country:US
Mailing Address - Phone:956-702-9933
Mailing Address - Fax:956-702-9966
Practice Address - Street 1:7209 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9685
Practice Address - Country:US
Practice Address - Phone:956-580-3143
Practice Address - Fax:956-702-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127729261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127729OtherDAHS LICENSE