Provider Demographics
NPI:1457474488
Name:MI DESTINO ADULT DAY CARE INC
Entity Type:Organization
Organization Name:MI DESTINO ADULT DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-797-5400
Mailing Address - Street 1:1140 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4418
Mailing Address - Country:US
Mailing Address - Phone:956-797-5400
Mailing Address - Fax:956-797-5411
Practice Address - Street 1:2805 W MEMORIAL
Practice Address - Street 2:STE A
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559
Practice Address - Country:US
Practice Address - Phone:956-797-5400
Practice Address - Fax:956-797-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116985261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care