1780712620 NPI number — ABREU ADULT CLINIC P A

Table of content: (NPI 1780712620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780712620 NPI number — ABREU ADULT CLINIC P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABREU ADULT CLINIC P A
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:
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:
1780712620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 S BRYAN RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-6658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-581-0539
Provider Business Mailing Address Fax Number:
956-323-1499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 S BRYAN RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-581-0539
Provider Business Practice Location Address Fax Number:
956-585-0745
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABREU-LAWRENCE
Authorized Official First Name:
CHARITY
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-581-0539

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  J8856 , 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: 096777002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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