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General NPI Number Information
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NPI Number | 1144559741
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Entity Type | Organization
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Legal Business Name | HEAVENLY PRIMARY HOMECARE, INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 12042 BAIL BOND DRIVE SUITE 2
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City | EDINBURG
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State | TX
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Zip | 78542-7705
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Country | US
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Telephone | 956-318-1554
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Fax | 956-316-0922
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Provider Business Mailing Address
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Address Line | 12042 BAIL BOND DR. SUITE 2
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City | EDINBURG
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State | TX
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Zip | 78542-7705
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Country | US
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Telephone | 956-318-1554
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Fax | 956-316-0922
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE I SOTO
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Credential |
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Telephone | 956-318-1554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 013217
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License Number State | TX
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