Provider Demographics
NPI:1467726067
Name:LAS JACARANDAS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LAS JACARANDAS ASSISTED LIVING LLC
Other - Org Name:LAS JACARANDAS ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:BARRIENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:956-550-0999
Mailing Address - Street 1:707 VILLA MARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6343
Mailing Address - Country:US
Mailing Address - Phone:956-550-0999
Mailing Address - Fax:956-550-0993
Practice Address - Street 1:707 VILLA MARIA BLVD
Practice Address - Street 2:4844 S, PASO DOBLE CIR,
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6343
Practice Address - Country:US
Practice Address - Phone:956-982-4495
Practice Address - Fax:956-550-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care