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General NPI Number Information
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NPI Number | 1912953845
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Entity Type | Organization
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Legal Business Name | CON BRAZOS ABIERTOS, LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 505 S TEXAS BLVD
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City | WESLACO
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State | TX
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Zip | 78596-6220
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Country | US
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Telephone | 956-968-9595
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Fax | 956-968-9661
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | WESLACO
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State | TX
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Zip | 78599-0010
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Country | US
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Telephone | 956-968-9595
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Fax | 956-968-9661
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JORGE GALLEGOS
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Credential |
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Telephone | 956-975-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010436
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License Number State | TX
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