=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316535677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAS BRISAS HOMECARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2021
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 DONNA RD
-----------------------------------------------------
City | PALMVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-7941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-424-6317
-----------------------------------------------------
Fax | 956-552-7447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 721004
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-904-5117
-----------------------------------------------------
Fax | 956-338-5657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOHOAN CARLOS MORENO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-424-6317
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------