Provider Demographics
NPI:1104004837
Name:ODP MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ODP MANAGEMENT, LLC
Other - Org Name:D'ORO PRIMARY HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-655-1273
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:ODP MANAGEMENT, LLC
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0267
Mailing Address - Country:US
Mailing Address - Phone:956-973-9765
Mailing Address - Fax:956-973-9766
Practice Address - Street 1:609 W 6TH ST STE 2
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-973-9700
Practice Address - Fax:956-973-9788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODP MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-05
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009435251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172428801Medicaid
=========OtherFED TAX ID NUMBER