Provider Demographics
NPI:1841241122
Name:MERIDA HEALTH CARE GROUP OF SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:MERIDA HEALTH CARE GROUP OF SAN ANTONIO, LLC
Other - Org Name:MERIDA HEALTH CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESQUIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-423-1197
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-1230
Mailing Address - Country:US
Mailing Address - Phone:956-423-1197
Mailing Address - Fax:956-440-1837
Practice Address - Street 1:2900 MOSSROCK
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5135
Practice Address - Country:US
Practice Address - Phone:210-923-7800
Practice Address - Fax:210-923-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002148251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024455001Medicaid
TX001004236OtherMDCP
45D0674071OtherCLIA
TX53333OtherMEDICAID DME H
45D0674071OtherCLIA