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General NPI Number Information
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NPI Number | 1336370287
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Entity Type | Organization
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Legal Business Name | TRINIDAD PHC
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 102 E. COLORADO AVE.
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City | RIO HONDO
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State | TX
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Zip | 78583-0247
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Country | US
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Telephone | 956-748-2657
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Fax | 956-748-2667
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Provider Business Mailing Address
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Address Line | P.O. BOX 247
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City | RIO HONDO
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State | TX
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Zip | 78583-0247
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Country | US
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Telephone | 956-748-2657
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Fax | 956-748-2667
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Authorized Official
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Title or Position | OWNER
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Name | IRAZEMA ROBERTS
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Credential |
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Telephone | 956-748-2657
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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