Provider Demographics
NPI:1720036551
Name:MANOS DE ORO PHC , INC.
Entity Type:Organization
Organization Name:MANOS DE ORO PHC , INC.
Other - Org Name:MANOS DE ORO PHC , INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAMEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-205-2644
Mailing Address - Street 1:302 TOM GILL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8464
Mailing Address - Country:US
Mailing Address - Phone:956-205-2644
Mailing Address - Fax:956-205-2908
Practice Address - Street 1:302 TOM GILL RD STE 5
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8464
Practice Address - Country:US
Practice Address - Phone:956-205-2644
Practice Address - Fax:956-205-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009787251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679516Medicare Oscar/Certification
TX679516Medicare PIN