Provider Demographics
NPI:1619499522
Name:HEARTS OF TEXAS PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:HEARTS OF TEXAS PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-666-9055
Mailing Address - Street 1:702 W INTERSTATE 2 STE C1
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6508
Mailing Address - Country:US
Mailing Address - Phone:956-666-9055
Mailing Address - Fax:956-517-2021
Practice Address - Street 1:702 W INTERSTATE 2 STE C1
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6508
Practice Address - Country:US
Practice Address - Phone:956-666-9055
Practice Address - Fax:956-517-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000Medicaid