MEDICARE: FIRST LIGHT PRIMARY HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912441080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST LIGHT PRIMARY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	23067 ROYAL PALM DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-4285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23067 ROYAL PALM DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-4285
Country	:	US
Telephone Number	:	956-230-3892
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WALLY GOMEZ
Credential	:
Telephone Number	:	956-357-1429

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	07/09/2024

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