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General NPI Number Information
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NPI Number | 1609107739
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Entity Type | Organization
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Legal Business Name | LA GUADALUPANA PRIMARY HOME CARE, LLC
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 338 N MONROE ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-4562
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Country | US
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Telephone | 830-758-1307
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Fax | 830-757-8503
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Provider Business Mailing Address
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Address Line | 338 N MONROE ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-4562
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Country | US
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Telephone | 830-758-1307
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Fax | 830-757-8503
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA GARZA
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Credential |
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Telephone | 830-758-1307
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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 | TX
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