Provider Demographics
NPI:1316075518
Name:EL#1ADULTDAYCARE
Entity type:Organization
Organization Name:EL#1ADULTDAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-636-1018
Mailing Address - Street 1:11861 WEST HWY 107
Mailing Address - Street 2:P.O.BOX323
Mailing Address - City:SANTA ROSA
Mailing Address - State:TX
Mailing Address - Zip Code:78593
Mailing Address - Country:US
Mailing Address - Phone:956-636-1018
Mailing Address - Fax:956-636-1720
Practice Address - Street 1:11861 WEST HWY 107
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:TX
Practice Address - Zip Code:78593
Practice Address - Country:US
Practice Address - Phone:956-636-1018
Practice Address - Fax:956-636-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115809261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care