Provider Demographics
NPI:1841485265
Name:LA CASA DE SUSY ADULT DAY CARE, LLC
Entity type:Organization
Organization Name:LA CASA DE SUSY ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHADWICK
Authorized Official - Last Name:NUNNERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-380-1133
Mailing Address - Street 1:1313 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5811
Mailing Address - Country:US
Mailing Address - Phone:956-380-1133
Mailing Address - Fax:956-380-1115
Practice Address - Street 1:1313 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5811
Practice Address - Country:US
Practice Address - Phone:956-380-1133
Practice Address - Fax:956-380-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120757261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care