MEDICARE: LA BENDICION PRIMARY HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	804087901	OTHER	TX	TEXAS SECRETARY OF STATE

General Provider Information

NPI Number	:	1518536978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA BENDICION PRIMARY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1431 W POLK AVE STE 110
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-2122
Country	:	US
Telephone Number	:	956-510-8058
Fax Number	:	956-510-8059

Provider Business Practice Location Address
First Line	:	1431 W POLK AVE STE 110
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-2122
Country	:	US
Telephone Number	:	956-510-8058
Fax Number	:	956-510-8059

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. GILBERTO DE LA GARZA HERNANDEZ
Credential	:
Telephone Number	:	956-510-8058

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/24/2021

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Directions to “LA BENDICION PRIMARY HOME CARE, LLC ” Practice Location

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