Provider Demographics
NPI:1477696680
Name:TEXAS PROVIDER CARE, LLC
Entity Type:Organization
Organization Name:TEXAS PROVIDER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:956-791-5234
Mailing Address - Street 1:1620 CHIHUAHUA ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3601
Mailing Address - Country:US
Mailing Address - Phone:956-791-5234
Mailing Address - Fax:956-726-0145
Practice Address - Street 1:1620 CHIHUAHUA ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043
Practice Address - Country:US
Practice Address - Phone:956-791-5234
Practice Address - Fax:956-726-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 385H00000X
TX009337251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012178Medicaid
TX001014972Medicaid