Provider Demographics
NPI:1386867653
Name:PASO DEL NORTE CHILDREN'S DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:PASO DEL NORTE CHILDREN'S DEVELOPMENT CENTER
Other - Org Name:PASO DEL NORTE CHILDREN'S DEVELOPMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:915-544-8484
Mailing Address - Street 1:1101 E SCHUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4659
Mailing Address - Country:US
Mailing Address - Phone:915-544-8484
Mailing Address - Fax:915-496-0751
Practice Address - Street 1:1101 E SCHUSTER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4659
Practice Address - Country:US
Practice Address - Phone:915-544-8484
Practice Address - Fax:915-496-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610670000252Y00000X
TX511030000252Y00000X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017438501Medicaid