Provider Demographics
NPI:1376917351
Name:MILAGRO HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MILAGRO HEALTHCARE SERVICES
Other - Org Name:MILAGRO ADULT FOSTER HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA-KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-642-4105
Mailing Address - Street 1:1140 ADA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2804
Mailing Address - Country:US
Mailing Address - Phone:915-642-4105
Mailing Address - Fax:
Practice Address - Street 1:1140 ADA LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2804
Practice Address - Country:US
Practice Address - Phone:915-642-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLHOC15-00236311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home