Provider Demographics
NPI:1306064183
Name:MELVA GONZALEZ
Entity type:Organization
Organization Name:MELVA GONZALEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-245-0035
Mailing Address - Street 1:1109 N 77 SUNSHINE STRIP
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8822
Mailing Address - Country:US
Mailing Address - Phone:956-245-0035
Mailing Address - Fax:956-425-9900
Practice Address - Street 1:1109 N 77 SUNSHINE STRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8822
Practice Address - Country:US
Practice Address - Phone:956-245-0035
Practice Address - Fax:956-425-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities