Provider Demographics
NPI:1487214821
Name:PALM VALLEY PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:PALM VALLEY PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-292-0920
Mailing Address - Street 1:209 E CANTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6228
Mailing Address - Country:US
Mailing Address - Phone:956-292-0920
Mailing Address - Fax:956-292-0923
Practice Address - Street 1:209 E CANTON RD STE A
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6228
Practice Address - Country:US
Practice Address - Phone:956-292-0920
Practice Address - Fax:956-292-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty