Provider Demographics
NPI:1982892766
Name:LAS FRONTERAS ADULT DAY CARE, INC.
Entity type:Organization
Organization Name:LAS FRONTERAS ADULT DAY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-421-2223
Mailing Address - Street 1:301 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8492
Mailing Address - Country:US
Mailing Address - Phone:956-421-2223
Mailing Address - Fax:956-421-2225
Practice Address - Street 1:301 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-421-2223
Practice Address - Fax:956-421-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121164261QA0600X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121164Medicaid
TX001012751Medicaid
TX001012751Medicaid