Provider Demographics
NPI:1568996080
Name:HEAVENLY STALLIONS P.H.C., L.L.C
Entity Type:Organization
Organization Name:HEAVENLY STALLIONS P.H.C., L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-460-2393
Mailing Address - Street 1:1400 N WESTGATE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-4329
Mailing Address - Country:US
Mailing Address - Phone:956-375-2009
Mailing Address - Fax:956-375-2047
Practice Address - Street 1:1400 N. WESTGATE DR.
Practice Address - Street 2:SUITE 205
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-7859
Practice Address - Country:US
Practice Address - Phone:956-375-2009
Practice Address - Fax:956-375-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3764912-01Medicaid