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General NPI Number Information
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NPI Number | 1376920355
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Entity Type | Organization
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Legal Business Name | PREMIERE ANGEL CARE HOME HEALTH
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 3248 WEST HWY 44
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City | ALICE
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State | TX
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Zip | 78332-9364
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Country | US
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Telephone | 361-661-9701
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Fax | 361-664-0676
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Provider Business Mailing Address
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Address Line | 233 COUNTY ROAD 133
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City | ALICE
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State | TX
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Zip | 78332-9364
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Country | US
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Telephone | 361-661-9701
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Fax | 361-664-0676
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARISSA BENAVIDES
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Credential | LVN
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Telephone | 361-661-9701
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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 | 015568
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License Number State | TX
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