Provider Demographics
NPI:1689881377
Name:MI NUEVO MUNDO ADULT DAY CARE
Entity Type:Organization
Organization Name:MI NUEVO MUNDO ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-4658
Mailing Address - Street 1:P O BOX 1351
Mailing Address - Street 2:
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560-1351
Mailing Address - Country:US
Mailing Address - Phone:956-583-4658
Mailing Address - Fax:956-583-7620
Practice Address - Street 1:220 W 1ST
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78650
Practice Address - Country:US
Practice Address - Phone:956-583-4658
Practice Address - Fax:956-583-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120280261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care