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General NPI Number Information
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NPI Number | 1952025942
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Entity Type | Organization
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Legal Business Name | ODESSA PREMIUM CARE
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 620 N GRANT AVE STE 903
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City | ODESSA
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State | TX
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Zip | 79761-4547
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Country | US
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Telephone | 702-376-2485
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N GRANT AVE STE 903
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City | ODESSA
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State | TX
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Zip | 79761-4547
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Country | US
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Telephone | 702-376-2485
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | IVAN GIL LLANES
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Credential |
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Telephone | 702-985-1399
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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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