Provider Demographics
NPI:1407227473
Name:CANUTILLO ADULT DAY CARE
Entity Type:Organization
Organization Name:CANUTILLO ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:915-222-5635
Mailing Address - Street 1:6845 DONIPHAN DR STE B
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-5048
Mailing Address - Country:US
Mailing Address - Phone:915-222-5635
Mailing Address - Fax:
Practice Address - Street 1:6845 DONIPHAN DR STE B
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-5048
Practice Address - Country:US
Practice Address - Phone:915-222-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LCE CORRAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000OtherNONE