Healthcare Provider Details

I. General information

NPI: 1023966124
Provider Name (Legal Business Name): SOUTH TEXAS PROVIDER AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E GARRISON ST
EAGLE PASS TX
78852-4930
US

IV. Provider business mailing address

1540 E GARRISON ST
EAGLE PASS TX
78852-4930
US

V. Phone/Fax

Practice location:
  • Phone: 830-335-3445
  • Fax:
Mailing address:
  • Phone: 830-335-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: GUADALUPE GONZALEZ
Title or Position: ADMINISTRATION
Credential:
Phone: 830-335-3445