=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104004837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODP MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 08/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 W 6TH ST STE 2
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-973-9700
-----------------------------------------------------
Fax | 956-973-9788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 267 ODP MANAGEMENT, LLC
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78599-0267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-973-9765
-----------------------------------------------------
Fax | 956-973-9766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOSE S RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-655-1273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009435
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | 009435
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------