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General NPI Number Information
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NPI Number | 1265064497
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Entity Type | Organization
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Legal Business Name | NOVAK PRIMARY HOME CARE LLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 3536 MONTCLAIR ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520-2100
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Country | US
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Telephone | 956-801-3100
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Fax | 956-801-3101
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Provider Business Mailing Address
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Address Line | 3536 MONTCLAIR ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520-2100
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Country | US
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Telephone | 956-801-3100
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Fax | 956-801-3101
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | ARNOLDO PENA
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Credential |
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Telephone | 956-801-3100
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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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