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General NPI Number Information
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NPI Number | 1568996080
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Entity Type | Organization
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Legal Business Name | HEAVENLY STALLIONS P.H.C., L.L.C
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1400 N. WESTGATE DR. SUITE 205
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City | WESLACO
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State | TX
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Zip | 78599-7859
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Country | US
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Telephone | 956-375-2009
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Fax | 956-375-2047
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Provider Business Mailing Address
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Address Line | 1400 N WESTGATE DR STE 205
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City | WESLACO
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State | TX
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Zip | 78599-4329
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Country | US
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Telephone | 956-375-2009
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Fax | 956-375-2047
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELISSA FLORES
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Credential |
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Telephone | 956-460-2393
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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