Provider Demographics
NPI:1831397165
Name:RIVERSIDE ADULT DAY CARE, INC
Entity type:Organization
Organization Name:RIVERSIDE ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:SEGOVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-504-1799
Mailing Address - Street 1:1474 W. PRICE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-504-1799
Mailing Address - Fax:956-504-2070
Practice Address - Street 1:1474 W PRICE RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8687
Practice Address - Country:US
Practice Address - Phone:956-504-1799
Practice Address - Fax:956-504-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120365251S00000X
251S00000X, 261QA0600X
TXDADS147869261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003730Medicaid