Provider Demographics
NPI:1629197033
Name:SANTA CRUZ DAY CARE FOR ADULTS, LLC
Entity Type:Organization
Organization Name:SANTA CRUZ DAY CARE FOR ADULTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EZEQUIEL
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-376-0450
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-2070
Mailing Address - Country:US
Mailing Address - Phone:956-255-4451
Mailing Address - Fax:
Practice Address - Street 1:834 PALM DR
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-2070
Practice Address - Country:US
Practice Address - Phone:956-262-6229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000331200261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care