Healthcare Provider Details

I. General information

NPI: 1346579265
Provider Name (Legal Business Name): AGUA CRISTALINA HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E JACKSON ST
HARLINGEN TX
78550-6845
US

IV. Provider business mailing address

109 E JACKSON ST
HARLINGEN TX
78550-6845
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-3095
  • Fax: 956-230-8180
Mailing address:
  • Phone: 956-365-3095
  • Fax: 956-230-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number016535
License Number StateTX

VIII. Authorized Official

Name: MANUEL ECHAVARRIA
Title or Position: ALTERNATE ADMINISTRATOR
Credential:
Phone: 956-407-6089