Provider Demographics
NPI:1831101880
Name:ANGELS OF MERCY HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTH, LLC
Other - Org Name:DBA ANGELS OF MERCY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGUAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-583-9995
Mailing Address - Street 1:910 E PALMA VISTA DR STE A
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2048
Mailing Address - Country:US
Mailing Address - Phone:956-583-9995
Mailing Address - Fax:956-583-1305
Practice Address - Street 1:910 E PALMA VISTA DR STE A
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-2048
Practice Address - Country:US
Practice Address - Phone:956-583-9995
Practice Address - Fax:956-583-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009584251E00000X
3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009584OtherHCSSA LICENSE NUMBER
TXCL8644OtherMEDICARE PART B
TX001015440OtherPHC
TX001015441OtherCBA
TX1730053-01Medicaid
TX009584OtherHCSSA LICENSE NUMBER