Provider Demographics
NPI:1376920355
Name:PREMIERE ANGEL CARE HOME HEALTH
Entity Type:Organization
Organization Name:PREMIERE ANGEL CARE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:361-661-9701
Mailing Address - Street 1:233 COUNTY ROAD 133
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-9364
Mailing Address - Country:US
Mailing Address - Phone:361-661-9701
Mailing Address - Fax:361-664-0676
Practice Address - Street 1:3248 WEST HWY 44
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-9364
Practice Address - Country:US
Practice Address - Phone:361-661-9701
Practice Address - Fax:361-664-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015568251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747917Medicare Oscar/Certification