Provider Demographics
NPI:1669651865
Name:MI PUEBLO ADULT DAY CARE INC.
Entity Type:Organization
Organization Name:MI PUEBLO ADULT DAY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,RN
Authorized Official - Phone:915-740-2782
Mailing Address - Street 1:681 HORIZON BLVD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4691
Mailing Address - Country:US
Mailing Address - Phone:915-860-8690
Mailing Address - Fax:915-860-7210
Practice Address - Street 1:681 HORIZON BLVD
Practice Address - Street 2:SUITE # E
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4691
Practice Address - Country:US
Practice Address - Phone:915-860-8690
Practice Address - Fax:915-860-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121409261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN