Provider Demographics
NPI:1205375763
Name:ENCINO PRIMARY HOME CARE LLC
Entity Type:Organization
Organization Name:ENCINO PRIMARY HOME CARE LLC
Other - Org Name:ENCINO PRIMARY HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-929-1054
Mailing Address - Street 1:309 W PIKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4723
Mailing Address - Country:US
Mailing Address - Phone:956-929-1054
Mailing Address - Fax:877-784-1426
Practice Address - Street 1:309 W PIKE BLVD STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4723
Practice Address - Country:US
Practice Address - Phone:956-929-1054
Practice Address - Fax:877-784-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385809401Medicaid