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Organization
SEVENTEEN LAC INC.
Active
Organization
SEVENTEEN LAC INC.
Active
Other names
Care Stat;'s Buena Aventura
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VERONICA CANTU (CEO/PRESIDENT)
(956) 727-1900
Entity
Organization
Contact information
Practice address
2412 JACAMAN RD, SUITE 104, LAREDO, TX 78041-6229
(956) 727-1900
(956) 727-1718
Mailing address
PO BOX 450249, LAREDO, TX 78045-0249
(956) 727-1900
(956) 727-1718
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
011500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74-7295
MEDICARE CERTIFICATION OR PTAN
TX
Enumeration date
09/20/2006
Last updated
12/12/2012
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