Provider Demographics
NPI:1710917406
Name:IPH PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:IPH PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-971-9732
Mailing Address - Street 1:1100 E JASMINE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4391
Mailing Address - Country:US
Mailing Address - Phone:956-971-9732
Mailing Address - Fax:956-971-9307
Practice Address - Street 1:1100 E JASMINE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4391
Practice Address - Country:US
Practice Address - Phone:956-971-9732
Practice Address - Fax:956-971-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health