Provider Demographics
NPI:1790187037
Name:EXPRESS PROVIDER AND HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:EXPRESS PROVIDER AND HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-295-1056
Mailing Address - Street 1:820 E HACKBERRY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5739
Mailing Address - Country:US
Mailing Address - Phone:956-295-1056
Mailing Address - Fax:
Practice Address - Street 1:820 E HACKBERRY AVE STE 106
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5739
Practice Address - Country:US
Practice Address - Phone:956-295-1056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health