Healthcare Provider Details

I. General information

NPI: 1699297895
Provider Name (Legal Business Name): ALPHA PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 FOREST LOOP
LAREDO TX
78045
US

IV. Provider business mailing address

624 FOREST LOOP
LAREDO TX
78045-8401
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-7701
  • Fax: 956-568-7733
Mailing address:
  • Phone: 956-568-7701
  • Fax: 956-568-7733

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE HERRERA
Title or Position: OWNER
Credential:
Phone: 956-568-7701