Provider Demographics
NPI:1407136476
Name:ILLUMINA LLC
Entity Type:Organization
Organization Name:ILLUMINA LLC
Other - Org Name:MERIDA HEALTH CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESQUIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-423-1197
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-1230
Mailing Address - Country:US
Mailing Address - Phone:956-423-1197
Mailing Address - Fax:956-440-1837
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:STE 212
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-853-2000
Practice Address - Fax:361-853-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
251J00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable