Provider Demographics
NPI:1336442110
Name:TRI-COUNTY KIDS CARE
Entity Type:Organization
Organization Name:TRI-COUNTY KIDS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-399-4500
Mailing Address - Street 1:1595 W US HIGHWAY 77 STE C
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4180
Mailing Address - Country:US
Mailing Address - Phone:956-399-4500
Mailing Address - Fax:815-301-9393
Practice Address - Street 1:1595 W US HIGHWAY 77 STE C
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4180
Practice Address - Country:US
Practice Address - Phone:956-399-4500
Practice Address - Fax:815-301-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation