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General NPI Number Information
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NPI Number | 1265600878
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY PHC
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Dates
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Enumeration Date | 02/16/2008
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Last Update Date | 02/16/2008
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Provider Practice Location Address
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Address Line | 270 FAY DR
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City | LYTLE
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State | TX
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Zip | 78052-3935
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Country | US
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Telephone | 210-705-1138
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Fax | 830-709-0201
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Provider Business Mailing Address
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Address Line | 270 FAY DR
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City | LYTLE
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State | TX
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Zip | 78052-3935
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Country | US
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Telephone | 210-705-1138
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Fax | 830-709-0201
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. JUAN RAMIREZ
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Credential |
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Telephone | 210-705-1138
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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 | TX
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