Provider Demographics
NPI:1760521371
Name:M'AGINE SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:M'AGINE SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:361-851-0311
Mailing Address - Street 1:6102 AYERS ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5697
Mailing Address - Country:US
Mailing Address - Phone:361-851-0311
Mailing Address - Fax:361-851-0991
Practice Address - Street 1:6102 AYERS ST STE 112
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5697
Practice Address - Country:US
Practice Address - Phone:361-851-0311
Practice Address - Fax:361-851-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001007966251B00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007966OtherHCS VENDOR NO.