Provider Demographics
NPI:1407409923
Name:BLANQUITA'S PRIMARY HOME CARE, LLC
Entity Type:Organization
Organization Name:BLANQUITA'S PRIMARY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:830-776-5031
Mailing Address - Street 1:1571 S VETERANS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6674
Mailing Address - Country:US
Mailing Address - Phone:830-776-5031
Mailing Address - Fax:830-776-5930
Practice Address - Street 1:1571 S VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6674
Practice Address - Country:US
Practice Address - Phone:830-776-5031
Practice Address - Fax:830-776-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841536638Medicaid