Provider Demographics
NPI:1609129352
Name:MGBR GROUP LLC
Entity Type:Organization
Organization Name:MGBR GROUP LLC
Other - Org Name:MGBR GROUP L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-519-4966
Mailing Address - Street 1:3800 N FM 492
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-4295
Mailing Address - Country:US
Mailing Address - Phone:956-519-4966
Mailing Address - Fax:
Practice Address - Street 1:3800 N FM 492
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574
Practice Address - Country:US
Practice Address - Phone:956-519-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145841261QA0600X, 305R00000X
TX135440305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care