Provider Demographics
NPI:1043411242
Name:ANGELITOS PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:ANGELITOS PRIMARY HOME CARE, INC.
Other - Org Name:ANGELITOS ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-6242
Mailing Address - Street 1:704 E GRIFFIN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2974
Mailing Address - Country:US
Mailing Address - Phone:956-581-6242
Mailing Address - Fax:956-581-9918
Practice Address - Street 1:704 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2922
Practice Address - Country:US
Practice Address - Phone:956-581-6242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0064603747P1801X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027280Medicaid
TX112800Medicaid