Provider Demographics
NPI:1679968671
Name:PRILEO HOME CARE TX LLC
Entity Type:Organization
Organization Name:PRILEO HOME CARE TX LLC
Other - Org Name:PRILEO HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-235-8582
Mailing Address - Street 1:8883 W FLAMINGO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8734
Mailing Address - Country:US
Mailing Address - Phone:702-209-2306
Mailing Address - Fax:702-209-3539
Practice Address - Street 1:18601 LBJ FWY STE 420
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6439
Practice Address - Country:US
Practice Address - Phone:214-570-7655
Practice Address - Fax:214-570-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349989901Medicaid