Provider Demographics
NPI:1639455363
Name:MJA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MJA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADORA
Authorized Official - Middle Name:ALABADO
Authorized Official - Last Name:USUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN, CCRN
Authorized Official - Phone:956-624-2587
Mailing Address - Street 1:4721 BUDDY OWENS AVE APT F
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4825
Mailing Address - Country:US
Mailing Address - Phone:956-994-0025
Mailing Address - Fax:956-994-0115
Practice Address - Street 1:4721 BUDDY OWENS AVE APT F
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4825
Practice Address - Country:US
Practice Address - Phone:956-994-0025
Practice Address - Fax:956-994-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104654310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility