Provider Demographics
NPI:1053608612
Name:PEACEFUL FOOTSTEPS GROUP HOME LLC
Entity type:Organization
Organization Name:PEACEFUL FOOTSTEPS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-907-2961
Mailing Address - Street 1:2041 ORCHID AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4153
Mailing Address - Country:US
Mailing Address - Phone:956-907-2961
Mailing Address - Fax:
Practice Address - Street 1:2041 ORCHID AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4153
Practice Address - Country:US
Practice Address - Phone:956-907-2961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherHEALTH CARE GROUP HOME