Provider Demographics
NPI:1295922607
Name:LAS FUENTES DAY TREATMENT CENTER
Entity type:Organization
Organization Name:LAS FUENTES DAY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-231-6328
Mailing Address - Street 1:2100 CORPUS CHRISTI ST
Mailing Address - Street 2:STE 15
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3361
Mailing Address - Country:US
Mailing Address - Phone:956-231-6328
Mailing Address - Fax:
Practice Address - Street 1:2100 CORPUS CHRISTI ST
Practice Address - Street 2:STE 15
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3361
Practice Address - Country:US
Practice Address - Phone:956-231-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)