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

Table of content: (NPI 1790058816)

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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