=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700250800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELES DIVINOS HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2015
-----------------------------------------------------
Last Update Date | 11/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 N ED CAREY DR SUITE B
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-343-5151
-----------------------------------------------------
Fax | 956-440-1287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1724 N ED CAREY DR SUITE B
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-343-5151
-----------------------------------------------------
Fax | 956-440-1287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. OSCAR C BURKHOLDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-343-5151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------