Healthcare Provider Details

I. General information

NPI: 1083756720
Provider Name (Legal Business Name): MIRASOL PRIMARY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E GRIFFIN PKWY SUITE C
MISSION TX
78572
US

IV. Provider business mailing address

710 E GRIFFIN PKWY SUITE C
MISSION TX
78572-2910
US

V. Phone/Fax

Practice location:
  • Phone: 956-581-1351
  • Fax: 956-581-2306
Mailing address:
  • Phone: 956-581-1351
  • Fax: 956-581-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number006581
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA BALDERAS
Title or Position: PRESIDENT
Credential: R.N.
Phone: 956-581-1351