Provider Demographics
NPI:1851672422
Name:MAMASITAS ADULT DAYCARE
Entity Type:Organization
Organization Name:MAMASITAS ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MISS
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-287-7770
Mailing Address - Street 1:4211 W STATE HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9461
Mailing Address - Country:US
Mailing Address - Phone:956-287-7770
Mailing Address - Fax:956-287-7771
Practice Address - Street 1:4211 W STATE HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9461
Practice Address - Country:US
Practice Address - Phone:956-287-7770
Practice Address - Fax:956-287-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102260302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization