Provider Demographics
NPI:1689734048
Name:JAIME RODRIGUEZ, INC.
Entity Type:Organization
Organization Name:JAIME RODRIGUEZ, INC.
Other - Org Name:MI CASA ADULT DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-381-1742
Mailing Address - Street 1:215 E CANO ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4509
Mailing Address - Country:US
Mailing Address - Phone:956-381-1742
Mailing Address - Fax:956-381-4308
Practice Address - Street 1:215 E CANO ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4509
Practice Address - Country:US
Practice Address - Phone:956-381-1742
Practice Address - Fax:956-381-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115253261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1014640Medicaid