NPIMap

Organization Active NPI

Maverick Adult Day Care L.L.C.

  • Home Health Agency
  • Eagle Pass, TX
National Provider Identifier
1730317322
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
009852 Issued in TX
Legal business name
MAVERICK ADULT DAY CARE L.L.C.
Practice address
3147 Megan St
Eagle Pass, TX 78852-5891
Phone
(830) 757-0966
Fax
(830) 757-0976
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Raphael Santana, R.N., BNS
Title
Admin
Phone
(830) 757-0966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 009852 TX Primary

Addresses

Primary practice location

3147 Megan St
Eagle Pass, TX 78852-5891

Mailing address

3147 Megan St
Eagle Pass, TX 78852-5891
Phone (830) 757-0966

Other identifiers 2

IdentifierTypeStateIssuer
192509104MedicaidTX
192509103MedicaidTX

Other names 1

  • Fort Duncan Home Health and Hospice Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eagle Pass Therapy Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3147 Megan St
Eagle Pass, TX 78852
Phone (830) 757-0966

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1730317322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3147 MEGAN ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525891",
            "telephone_number": "830-757-0966",
            "fax_number": "830-757-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3147 MEGAN ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525891",
            "telephone_number": "830-757-0966",
            "fax_number": "830-757-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK ADULT DAY CARE L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "SANTANA",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "830-757-0966",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.N., BNS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "009852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192509104",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192509103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Duncan Home Health and Hospice Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle Pass, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.