Provider Demographics
NPI:1700014073
Name:PALM VILLA ADULT DAYCARE FACILITY
Entity Type:Organization
Organization Name:PALM VILLA ADULT DAYCARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-584-6700
Mailing Address - Street 1:2402 BROCK ST STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3257
Mailing Address - Country:US
Mailing Address - Phone:956-584-6700
Mailing Address - Fax:956-583-7793
Practice Address - Street 1:2308 HWY 83 STE D
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8399
Practice Address - Country:US
Practice Address - Phone:956-584-6700
Practice Address - Fax:956-583-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care