Healthcare Provider Details

I. General information

NPI: 1770708265
Provider Name (Legal Business Name): MIZPAH RESIDENTIAL CARE. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E GRIMES ST
HARLINGEN TX
78550-8881
US

IV. Provider business mailing address

902 E GRIMES ST
HARLINGEN TX
78550-8881
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-3646
  • Fax: 956-365-3651
Mailing address:
  • Phone: 956-365-3646
  • Fax: 956-365-3651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number008379
License Number StateTX

VIII. Authorized Official

Name: MR. CHUTEI VARKEY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 956-365-3646