Provider Demographics
NPI:1083636112
Name:ALICE PRIMARY SERVICES, INC.
Entity Type:Organization
Organization Name:ALICE PRIMARY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINGA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-241-6411
Mailing Address - Street 1:9806 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-1612
Mailing Address - Country:US
Mailing Address - Phone:361-241-6411
Mailing Address - Fax:361-241-6886
Practice Address - Street 1:9806 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-1612
Practice Address - Country:US
Practice Address - Phone:361-241-6411
Practice Address - Fax:361-241-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005937251E00000X, 253Z00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care