M'Agine Support Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

M'AGINE SUPPORT SERVICES, LLC

Practice address

6102 Ayers St Ste 102
Corpus Christi, TX 78415-5697

Phone

(361) 851-0311

Fax

(361) 851-0990

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Rodolfo Moreno Jr., M.S.

Title

Administrator

Phone

(361) 851-0311

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1760521371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6102 AYERS ST STE 102",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784155697",
            "telephone_number": "361-851-0311",
            "fax_number": "361-851-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6102 AYERS ST STE 102",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784155697",
            "telephone_number": "361-851-0311",
            "fax_number": "361-851-0990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4626 Weber Rd",
            "address_2": "Suite 21",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784113543",
            "country_code": "US",
            "telephone_number": "361-851-0311",
            "fax_number": "361-851-0990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "M'AGINE SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "RODOLFO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "361-851-0311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "TX",
            "license": "001007966",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCS VENDOR NO.",
            "identifier": "001007966",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy L Lykos, D.D.S.
• Jerry Douglas Lynch, PA
• Tabitha Lytle, PHARMD
• M Ayman Ghraowi, MD PA (Northwest Cancer Center)
• M Hernandez MD PLLC
• M'Agine Supported Living
• Ali Abdalla Maawy, M.D
• Faith Ebangha Mabo, APRN-CNP
• Mildred Necesario Macasinag, PHYSICAL THERAPIST
• Brandon David Macias, FNP-C

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.