Provider Demographics
NPI:1538270608
Name:EL SHADDAI INTERNATIONAL CHRISTIAN CENTER
Entity type:Organization
Organization Name:EL SHADDAI INTERNATIONAL CHRISTIAN CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:956-472-9234
Mailing Address - Street 1:723 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6617
Mailing Address - Country:US
Mailing Address - Phone:956-968-8814
Mailing Address - Fax:956-447-8349
Practice Address - Street 1:723 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6617
Practice Address - Country:US
Practice Address - Phone:956-968-8814
Practice Address - Fax:956-447-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116731261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000334000Medicaid