Healthcare Provider Details

I. General information

NPI: 1417361445
Provider Name (Legal Business Name): PRTRIO HOSPICE - RURAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 SARATOGA BLVD SUITE 420
CORPUS CHRISTI TX
78414-4103
US

IV. Provider business mailing address

304 E SAN PATRICIO AVE
MATHIS TX
78368-2350
US

V. Phone/Fax

Practice location:
  • Phone: 361-779-5456
  • Fax: 361-991-0181
Mailing address:
  • Phone: 361-779-5456
  • Fax: 361-991-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HAITHAM JIFI BAHLOOL
Title or Position: PRESIDENT
Credential: MD
Phone: 361-779-5456