Provider Demographics
NPI:1831364694
Name:ESPERANZA ADULT FOSTER CARE
Entity type:Organization
Organization Name:ESPERANZA ADULT FOSTER CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CARETAKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-256-3462
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:CLINT
Mailing Address - State:TX
Mailing Address - Zip Code:79836-1877
Mailing Address - Country:US
Mailing Address - Phone:915-256-3462
Mailing Address - Fax:
Practice Address - Street 1:12080 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:CLINT
Practice Address - State:TX
Practice Address - Zip Code:79836-6703
Practice Address - Country:US
Practice Address - Phone:915-256-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization