Provider Demographics
NPI:1902263478
Name:ELDORADO TEXAS COMMUNITY SERVICE CENTER
Entity Type:Organization
Organization Name:ELDORADO TEXAS COMMUNITY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-6630
Mailing Address - Street 1:954 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5950
Mailing Address - Country:US
Mailing Address - Phone:661-254-6630
Mailing Address - Fax:661-254-6644
Practice Address - Street 1:5510 N CAGE BLVD STE P
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1813
Practice Address - Country:US
Practice Address - Phone:956-787-3544
Practice Address - Fax:956-787-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000016OtherSTATE NTP LICENSE