Provider Demographics
NPI:1689872087
Name:RICHARD GARZA DBA LA GUADALUPANA PRIMARY HOME CARE AGENCY
Entity Type:Organization
Organization Name:RICHARD GARZA DBA LA GUADALUPANA PRIMARY HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-758-1307
Mailing Address - Street 1:338 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4562
Mailing Address - Country:US
Mailing Address - Phone:830-758-1307
Mailing Address - Fax:830-757-8503
Practice Address - Street 1:338 N MONROE ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4562
Practice Address - Country:US
Practice Address - Phone:830-758-1307
Practice Address - Fax:830-757-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007185251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001121OtherVENDOR NUMBER