Healthcare Provider Details

I. General information

NPI: 1174126163
Provider Name (Legal Business Name): CMS PROVIDER SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 LAKE KARIBA
LAREDO TX
78041-1959
US

IV. Provider business mailing address

303 LAKE KARIBA
LAREDO TX
78041-1959
US

V. Phone/Fax

Practice location:
  • Phone: 956-727-9300
  • Fax: 956-726-9305
Mailing address:
  • Phone: 956-727-9300
  • Fax: 956-726-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RONDA D DEVALLY
Title or Position: OWNER
Credential:
Phone: 956-727-9300