1790058816 NPI number — NUESTRA FAMILIA ADULT DAY CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790058816 NPI number — NUESTRA FAMILIA ADULT DAY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUESTRA FAMILIA ADULT DAY CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790058816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 S UTAH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78596-5861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-969-0204
Provider Business Mailing Address Fax Number:
956-969-1715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 E BUSINESS HIGHWAY 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-6355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-973-2200
Provider Business Practice Location Address Fax Number:
956-968-1500
Provider Enumeration Date:
02/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VALERIO-SALINAS
Authorized Official First Name:
IRMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ADMINISTRATOR
Authorized Official Telephone Number:
956-789-3354

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  129963 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001014497 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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