Basic Information
| Provider Information | |||||||||
| NPI: | 1902263478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELDORADO TEXAS COMMUNITY SERVICE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 954 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785205950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612546630 | ||||||||
| FaxNumber: | 6612546644 | ||||||||
| Practice Location | |||||||||
| Address1: | 5510 N CAGE BLVD STE P | ||||||||
| Address2: | |||||||||
| City: | PHARR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785771813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567873544 | ||||||||
| FaxNumber: | 9567873548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2016 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHARMA | ||||||||
| AuthorizedOfficialFirstName: | PRAMESH | ||||||||
| AuthorizedOfficialMiddleName: | PRAKASH | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 6613135503 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 1000016 | 01 | TX | STATE NTP LICENSE | OTHER |