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General NPI Number Information
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NPI Number | 1639531197
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Entity Type | Organization
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Legal Business Name | PROVISION HOME CARE SERVICES, LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 01/30/2022
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Provider Practice Location Address
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Address Line | 617 S TEXAS BLVD, STE A
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City | WESLACO
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State | TX
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Zip | 78596
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Country | US
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Telephone | 956-854-4518
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Fax | 956-854-4488
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Provider Business Mailing Address
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Address Line | PO BOX 163
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City | WESLACO
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State | TX
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Zip | 78599-0163
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Country | US
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Telephone | 956-854-4518
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Fax | 956-854-4488
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Authorized Official
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Title or Position | DON/ADMINISTRATOR
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Name | MS. MARISELA GONZALEZ
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Credential | RN, BSN
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Telephone | 956-975-9264
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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 | 017533
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License Number State | TX
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