=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851613962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELEON PRIMARY HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2010
-----------------------------------------------------
Last Update Date | 02/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1519 WASHINGTON ST STE 1
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78040-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-727-7775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1519 WASHINGTON ST
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78040-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-727-7775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GUADALUPE DE LEON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-727-7775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010913
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------