Provider Demographics
NPI:1518395631
Name:VIDA NUEVA ADULT DAY CARE
Entity type:Organization
Organization Name:VIDA NUEVA ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESPERANZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-694-2445
Mailing Address - Street 1:409 W ZAVALA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-3241
Mailing Address - Country:US
Mailing Address - Phone:830-854-2001
Mailing Address - Fax:830-854-2150
Practice Address - Street 1:409 W ZAVALA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3241
Practice Address - Country:US
Practice Address - Phone:830-854-2001
Practice Address - Fax:830-854-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139178261QA0600X
TX302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care