Provider Demographics
NPI:1053068585
Name:FAMILY PROVIDER SERVICE, LLC.
Entity Type:Organization
Organization Name:FAMILY PROVIDER SERVICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-358-9192
Mailing Address - Street 1:1124 N INTERNATIONAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-2539
Mailing Address - Country:US
Mailing Address - Phone:956-358-9192
Mailing Address - Fax:956-627-3164
Practice Address - Street 1:1124 N INTERNATIONAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-2539
Practice Address - Country:US
Practice Address - Phone:956-358-9192
Practice Address - Fax:956-627-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty