1780619031 NPI number — ELSA THERAPY & WELLNESS CENTER, INC.

Table of content: (NPI 1780619031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780619031 NPI number — ELSA THERAPY & WELLNESS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELSA THERAPY & WELLNESS CENTER, 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:
1780619031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-262-1037
Provider Business Mailing Address Fax Number:
956-262-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 W. EDINBURG AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ELSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-262-1037
Provider Business Practice Location Address Fax Number:
956-262-7756
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
956-461-2309

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  37129 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X , with the licence number: 208752 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1131290 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 110383 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: 11512 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 2064523 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 112802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: 34009 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: 34739 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 102929 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: M2376 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: K8596 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: 34195 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: 12390 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , 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: 141479 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1834772-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 660900000 . This is a "PHYSICAL THERAPY FACILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0009PG . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1834772-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 555000000 . This is a "OCCUPATIONAL THERAPY FACI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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