Provider Demographics
NPI:1386689750
Name:PROFESSIONAL PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-718-3000
Mailing Address - Street 1:213 W VILLAGE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2283
Mailing Address - Country:US
Mailing Address - Phone:956-725-3003
Mailing Address - Fax:956-723-1336
Practice Address - Street 1:213 W VILLAGE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2283
Practice Address - Country:US
Practice Address - Phone:956-725-3003
Practice Address - Fax:956-723-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007798251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health