=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962753798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM VALLEY PROVIDER SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2012
-----------------------------------------------------
Last Update Date | 09/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 E CANTON RD STE. A
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-6228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-292-0920
-----------------------------------------------------
Fax | 956-292-0923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 E CANTON RD. STE. A
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-292-0920
-----------------------------------------------------
Fax | 956-292-0923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTER
-----------------------------------------------------
Name | ALEJANDRO FLORES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-292-0920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------