Healthcare Provider Details

I. General information

NPI: 1659841740
Provider Name (Legal Business Name): J & A TENDER CARE PRIMARY CARE L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN EDUARDO AVE
LAREDO TX
78040-7523
US

IV. Provider business mailing address

1310 SAN EDUARDO AVE
LAREDO TX
78040-7523
US

V. Phone/Fax

Practice location:
  • Phone: 956-652-9507
  • Fax: 956-704-5059
Mailing address:
  • Phone: 956-652-9507
  • Fax: 956-704-5059

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOE ALBERT GOMEZ
Title or Position: ALT. ADMINSTARTOR
Credential:
Phone: 956-652-9507