=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811212384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRO-HEALTH HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2010
-----------------------------------------------------
Last Update Date | 03/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2402 N HWY 77 SUITE Q
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-970-8424
-----------------------------------------------------
Fax | 888-516-5320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 532021
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78553-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-970-8424
-----------------------------------------------------
Fax | 888-516-5320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. JOSUE ALVARADO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 956-970-8424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------