Provider Demographics
NPI:1386691095
Name:MAVERICK ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:MAVERICK ADULT DAY CARE, LLC
Other - Org Name:EAGLE PASS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-758-0366
Mailing Address - Street 1:2499 N VETERANS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6644
Mailing Address - Country:US
Mailing Address - Phone:830-758-0366
Mailing Address - Fax:830-758-0365
Practice Address - Street 1:2499 N VETERANS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6644
Practice Address - Country:US
Practice Address - Phone:830-758-0366
Practice Address - Fax:830-758-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069NFOtherCLINIC-BCBS
TX8T6180OtherPROVIDER-BCBS
TX0069NFOtherCLINIC-BCBS
TX8T6180OtherPROVIDER-BCBS
TXP00347706Medicare ID - Type UnspecifiedTHERAPIST
TX00W116Medicare ID - Type UnspecifiedCLINIC-GROUP