Provider Demographics
NPI:1821256660
Name:EDINBURG ADULT DAY CARE
Entity Type:Organization
Organization Name:EDINBURG ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:956-238-9107
Mailing Address - Street 1:10205 LIPSEY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-1661
Mailing Address - Country:US
Mailing Address - Phone:956-238-9107
Mailing Address - Fax:956-287-1332
Practice Address - Street 1:910 E MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-8635
Practice Address - Country:US
Practice Address - Phone:956-383-3383
Practice Address - Fax:956-287-1332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOY MARTIN ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101368261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care