Maverick Adult Day Care LLC.
Organization Active NPI Community Based Hospice Care Agency · Eagle Pass, TX
NPI 1770515561 · NPPES record last updated Jan 15, 2025
Key facts
- NPI
- 1770515561
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 009852 (TX)
- Legal business name
- MAVERICK ADULT DAY CARE LLC.
- Practice address
- 2557 N Veterans Blvd Ste E
Eagle Pass, TX 78852-3390 - Phone
- (830) 757-0966
- Fax
- (830) 757-0976
- NPI assigned
- Jul 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Gerardo Villalpando
- Title
- Cfo
- Phone
- (830) 757-0966
Owners & managing parties with NPI records 1
-
Claudia Alicia Auces-Santana, FNP-BC
Practitioners 1
-
Raphael Santana, FNP
Affiliated clinicians 3
-
Laura Givens, MD
Medicare Care Compare: Hospice
- Listed as
- Haven Hospice
- Ownership
- Other
- Certified
- Jan 27, 2004
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospice certification: CCN 451745
- Legal name
- MAVERICK ADULT DAY CARE LLC
- Doing business as
- HAVEN HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 27, 2004
- Last certification
- Aug 31, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 1, 2004 in TX
- Enrollment address
- 2557 N Veterans Blvd
Ste E
Eagle Pass, TX 78852-3390
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Claudia a Auces-Santana |
5% Or Greater Direct Ownership Interest |
Aug 15, 2020 | 100% |
| Corporate Officer |
Aug 15, 2020 | 100% | |
| Raphael Santana |
Corporate Officer |
Aug 15, 2020 | |
| W-2 Managing Employee |
Aug 15, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050503000089 | TX | Part a Provider - Hospice | 2264471879 | Practice locations: Eagle Pass, TX |
National Provider Directory
Locations
3147 Megan St
Ste 1
Eagle Pass, TX 78852
Phone (830) 757-0966
2557 N Veterans Blvd
Ste E
Eagle Pass, TX 78852
Phone (830) 757-0966
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 009852 | TX | |
| Community Based Hospice Care Agency | 251G00000X | 009852 | TX | Yes |
Addresses
Primary practice location
2557 N Veterans Blvd Ste E
Eagle Pass, TX 78852-3390
Mailing address
2557 N Veterans Blvd Ste E
Eagle Pass, TX 78852-3390
Phone (830) 757-0966
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001014120 | Medicaid | TX |
Other names
- Haven Hospice
Other providers in Eagle Pass, TX
- Elizabeth Martinez
- Hilda Patricia Martinez
- Jorge Alberto Martinez Jr.
- Maria Luisa Mauricio
- Maverick Adult Day Care L.L.C.
- Maverick Adult Day Care, LLC
- Maverick Ambulance Service, Inc
- Maverick County Association for Persons With Disabilities
- Maverick County Hospital District
- Maverick County Hospital District
All providers in Eagle Pass, TX · Community Based Hospice Care Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.