Healthcare Provider Details

I. General information

NPI: 1679889596
Provider Name (Legal Business Name): CMS PRIMARY HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 DOHERTY AVE STE 5
MISSION TX
78572-4019
US

IV. Provider business mailing address

1524 DOHERTY AVE STE 5
MISSION TX
78572-4019
US

V. Phone/Fax

Practice location:
  • Phone: 956-424-9897
  • Fax:
Mailing address:
  • Phone: 956-424-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA ELENA GUTIERREZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 956-424-9897