Provider Demographics
NPI:1053528919
Name:MY GOLDEN YEARS II
Entity type:Organization
Organization Name:MY GOLDEN YEARS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-487-4110
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:GRULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78548-0419
Mailing Address - Country:US
Mailing Address - Phone:956-487-4110
Mailing Address - Fax:956-488-8145
Practice Address - Street 1:359 PVT LEOPOLDO LONGORIA ST
Practice Address - Street 2:
Practice Address - City:LA GRULLA
Practice Address - State:TX
Practice Address - Zip Code:78548
Practice Address - Country:US
Practice Address - Phone:956-487-4110
Practice Address - Fax:956-488-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117169261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care