Healthcare Provider Details

I. General information

NPI: 1912101023
Provider Name (Legal Business Name): NUESTRO SAGRADO CORAZON PRIMARY HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 S JACKSON RD
EDINBURG TX
78539-9793
US

IV. Provider business mailing address

4811 S JACKSON RD
EDINBURG TX
78539-9793
US

V. Phone/Fax

Practice location:
  • Phone: 956-627-3434
  • Fax: 956-627-3699
Mailing address:
  • Phone: 956-627-3434
  • Fax: 956-627-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010559
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANA MARIA HERNANDEZ
Title or Position: ADMINISTRATOR/SIGNING AUTHORITY
Credential:
Phone: 956-968-9828