Provider Demographics
NPI:1174042097
Name:MI RANCHITO PHC LLC
Entity Type:Organization
Organization Name:MI RANCHITO PHC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-519-8886
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560-2003
Mailing Address - Country:US
Mailing Address - Phone:956-519-8888
Mailing Address - Fax:956-519-8887
Practice Address - Street 1:824 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-4178
Practice Address - Country:US
Practice Address - Phone:956-519-8886
Practice Address - Fax:956-519-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty