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General NPI Number Information
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NPI Number | 1407409923
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Entity Type | Organization
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Legal Business Name | BLANQUITA'S PRIMARY HOME CARE, LLC
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 1571 S VETERANS BLVD STE A
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City | EAGLE PASS
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State | TX
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Zip | 78852-6674
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Country | US
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Telephone | 830-776-5031
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Fax | 830-776-5031
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Provider Business Mailing Address
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Address Line | 1571 S VETERANS BLVD STE A
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City | EAGLE PASS
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State | TX
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Zip | 78852-6674
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Country | US
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Telephone | 830-776-5031
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Fax | 830-776-5930
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. BLANCA E PERALES
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Credential | LVN
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Telephone | 830-776-5031
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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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