Healthcare Provider Details

I. General information

NPI: 1477729523
Provider Name (Legal Business Name): PTL KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 BOCA CHICA BLVD STE 300
BROWNSVILLE TX
78520-8145
US

IV. Provider business mailing address

1740 BOCA CHICA BLVD STE 300
BROWNSVILLE TX
78520-8145
US

V. Phone/Fax

Practice location:
  • Phone: 956-838-1801
  • Fax: 956-838-0170
Mailing address:
  • Phone: 956-838-1801
  • Fax: 956-838-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSAURA RIVERA
Title or Position: OWNER, ALT. ADM / ALT. DON
Credential: RN
Phone: 956-838-1801