Provider Demographics
NPI:1871822296
Name:EL ORO DEL PUEBLO SERVICE INC
Entity Type:Organization
Organization Name:EL ORO DEL PUEBLO SERVICE INC
Other - Org Name:ORO DEL PUEBLO ADULT DAYCARE #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW AP
Authorized Official - Phone:956-968-1271
Mailing Address - Street 1:P.O. BOX 267
Mailing Address - Street 2:
Mailing Address - City:WESLAC0
Mailing Address - State:TX
Mailing Address - Zip Code:78599
Mailing Address - Country:US
Mailing Address - Phone:956-968-1271
Mailing Address - Fax:956-973-9788
Practice Address - Street 1:508 S STANDARD AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2443
Practice Address - Country:US
Practice Address - Phone:956-782-1000
Practice Address - Fax:956-782-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117622261QA0600X
TX115767261QA0600X
TX117281261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285701904Medicaid
TX1447327135Medicaid
TX1053488239Medicaid