Provider Demographics
NPI:1750674776
Name:ST JOHN'S PHC, LLC
Entity Type:Organization
Organization Name:ST JOHN'S PHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-534-5439
Mailing Address - Street 1:213 E FERGUSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1827
Mailing Address - Country:US
Mailing Address - Phone:956-534-5439
Mailing Address - Fax:
Practice Address - Street 1:213 E FERGUSON ST STE B
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1827
Practice Address - Country:US
Practice Address - Phone:956-534-5439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care