Healthcare Provider Details

I. General information

NPI: 1174305320
Provider Name (Legal Business Name): CMS HEALTHCARE PROVIDER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 QUINTERO ST
LAREDO TX
78045-5001
US

IV. Provider business mailing address

3110 QUINTERO ST
LAREDO TX
78045-5001
US

V. Phone/Fax

Practice location:
  • Phone: 956-898-9399
  • Fax: 956-726-9305
Mailing address:
  • Phone: 956-898-9399
  • Fax: 956-726-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN PENA
Title or Position: PRESIDENT
Credential: CEO
Phone: 956-898-9399