Provider Demographics
NPI:1811350721
Name:MORNING DOVE ADULT DAYCARE
Entity type:Organization
Organization Name:MORNING DOVE ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-782-5525
Mailing Address - Street 1:1210 W EXPY 83 STE 4
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6504
Mailing Address - Country:US
Mailing Address - Phone:956-782-5525
Mailing Address - Fax:956-752-5500
Practice Address - Street 1:1210 W EXPY 83 STE 4
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6504
Practice Address - Country:US
Practice Address - Phone:956-782-5525
Practice Address - Fax:956-752-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142877261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care