Provider Demographics
NPI:1790081693
Name:VIDA ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:VIDA ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDERAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-825-7205
Mailing Address - Street 1:301 VOGEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4324
Mailing Address - Country:US
Mailing Address - Phone:956-825-7205
Mailing Address - Fax:956-825-7206
Practice Address - Street 1:301 VOGEL DRIVE
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-4324
Practice Address - Country:US
Practice Address - Phone:956-825-7205
Practice Address - Fax:956-825-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
TX132778261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020174Medicaid