Provider Demographics
NPI:1396979415
Name:MOM AND DAD ADC LLC
Entity type:Organization
Organization Name:MOM AND DAD ADC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-734-5440
Mailing Address - Street 1:1514 S. 77 SUNSHINE STRIP #28
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-734-5440
Mailing Address - Fax:956-734-5393
Practice Address - Street 1:1514 S. 77 SUNSHINE STRIP #28
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-734-5440
Practice Address - Fax:956-734-5393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOM AND DAD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126647261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396979415Medicaid