Provider Demographics
NPI:1356518195
Name:SU CASA ADULT DAY CARE II
Entity type:Organization
Organization Name:SU CASA ADULT DAY CARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:956-969-3656
Mailing Address - Street 1:318 W RAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-702-3870
Mailing Address - Fax:956-702-3875
Practice Address - Street 1:1305 E JUAREZ
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-702-3870
Practice Address - Fax:956-702-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care