Healthcare Provider Details

I. General information

NPI: 1730896762
Provider Name (Legal Business Name): MI REFUGIO HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 MCPHERSON RD STE 204
LAREDO TX
78041
US

IV. Provider business mailing address

4001 MCPHERSON RD STE 204
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 956-477-6260
  • Fax: 956-568-9679
Mailing address:
  • Phone: 956-477-6260
  • Fax: 956-568-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ANA CANTU
Title or Position: OWNER/VICE PRESIDENT
Credential:
Phone: 956-603-0883