Organization
M'AGINE SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODOLFO MORENO JR. M.S. (ADMINISTRATOR)
(361) 851-0311
Entity
Organization
Contact information
Practice address
6102 AYERS ST STE 102, CORPUS CHRISTI, TX 78415-5697
(361) 851-0311
(361) 851-0990
Mailing address
6102 AYERS ST STE 102, CORPUS CHRISTI, TX 78415-5697
(361) 851-0311
(361) 851-0991
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
001007966
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001007966
HCS VENDOR NO.
TX
Enumeration date
02/06/2007
Last updated
09/23/2024
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