Provider Demographics
NPI:1447289657
Name:EDINBURG ADULT DAY CARE
Entity type:Organization
Organization Name:EDINBURG ADULT DAY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-464-7741
Mailing Address - Street 1:2115 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-5633
Mailing Address - Country:US
Mailing Address - Phone:956-464-7741
Mailing Address - Fax:956-464-0007
Practice Address - Street 1:1206 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3706
Practice Address - Country:US
Practice Address - Phone:956-380-3933
Practice Address - Fax:956-380-6828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDINBURG ADULT DAY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117166261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1014810Medicaid
TXTX108-6106Medicaid
TX117166Medicaid
TX001004787Medicaid
TX1014810Medicaid