Provider Demographics
NPI:1154513810
Name:CORAZON CON CORAZON ADULT DAY CARE, LLC
Entity type:Organization
Organization Name:CORAZON CON CORAZON ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-584-7001
Mailing Address - Street 1:1300 S BRYAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6626
Mailing Address - Country:US
Mailing Address - Phone:956-584-7001
Mailing Address - Fax:956-584-7024
Practice Address - Street 1:1300 S BRYAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6626
Practice Address - Country:US
Practice Address - Phone:956-584-7001
Practice Address - Fax:956-584-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001017109Medicaid