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General NPI Number Information
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NPI Number | 1750046777
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Entity Type | Organization
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Legal Business Name | DE VINE PRIMARY HOME CARE LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1524 N CONWAY AVE
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City | MISSION
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State | TX
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Zip | 78572-4003
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Country | US
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Telephone | 956-890-0222
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Fax | 956-598-5999
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Provider Business Mailing Address
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Address Line | 3003 WISTERIA DR
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City | MISSION
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State | TX
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Zip | 78574-2074
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Country | US
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Telephone | 956-890-0222
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. ANDRINA DE ANDA
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Credential |
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Telephone | 956-890-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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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 | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #7
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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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