=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659325199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E.L. PANCIERA, INC. DBA ADVANCE PLUS HH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 11/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 BOCA CHICA BLVD STE C
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-7895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-546-9444
-----------------------------------------------------
Fax | 956-546-9477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 BOCA CHICA BLVD STE C
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-7895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-546-9444
-----------------------------------------------------
Fax | 956-546-9477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EMIL L PANCIERA
-----------------------------------------------------
Credential | RRT, BAAS
-----------------------------------------------------
Telephone | 956-546-9444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 007610
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------