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General NPI Number Information
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NPI Number | 1033630595
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Entity Type | Organization
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Legal Business Name | GRATEFUL PRIMARY HOME CARE
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 217 DESERT CHIEF DR
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City | LAREDO
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State | TX
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Zip | 78045-4187
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Country | US
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Telephone | 956-319-1968
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Fax |
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Provider Business Mailing Address
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Address Line | 217 DESERT CHIEF DR
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City | LAREDO
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State | TX
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Zip | 78045-4187
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Country | US
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Telephone | 956-319-1968
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PRISCILLA CARDENAS
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Credential |
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Telephone | 956-319-1968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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