Provider Demographics
NPI:1003145822
Name:LA GUADALUPANA PRIMARY HOME CARE, LLC
Entity Type:Organization
Organization Name:LA GUADALUPANA PRIMARY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-758-1307
Mailing Address - Street 1:338 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4562
Mailing Address - Country:US
Mailing Address - Phone:830-758-1307
Mailing Address - Fax:830-757-8503
Practice Address - Street 1:913 E HARRISON AVE STE 7
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7193
Practice Address - Country:US
Practice Address - Phone:956-428-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty