Provider Demographics
NPI:1841536638
Name:BLANQUITA'S ADULT DAY CARE CENTER LLC
Entity type:Organization
Organization Name:BLANQUITA'S ADULT DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ALT. ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN EDUCATION
Authorized Official - Phone:830-352-4013
Mailing Address - Street 1:1537 S VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6474
Mailing Address - Country:US
Mailing Address - Phone:830-352-4013
Mailing Address - Fax:830-752-6299
Practice Address - Street 1:1537 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6474
Practice Address - Country:US
Practice Address - Phone:830-352-4013
Practice Address - Fax:830-752-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-24
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841536638Medicaid