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General NPI Number Information
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NPI Number | 1821620337
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Entity Type | Organization
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Legal Business Name | DE LOS SANTOS PRIMARY HOME CARE, LLC.
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 304 S ALAMO RD STE A
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City | ALAMO
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State | TX
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Zip | 78516-2728
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Country | US
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Telephone | 956-373-9868
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Fax | 956-435-0105
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Provider Business Mailing Address
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Address Line | 939 S 13TH ST STE A
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City | ALAMO
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State | TX
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Zip | 78516-7233
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Country | US
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Telephone | 956-373-9868
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Fax | 956-435-0105
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Authorized Official
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Title or Position | CEO
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Name | LIZETTE IVY DE LOS SANTOS
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Credential |
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Telephone | 956-373-9868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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