Provider Demographics
NPI:1851682231
Name:LIONSITOS PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:LIONSITOS PRIMARY HOME CARE, INC.
Other - Org Name:LIONSITOS PRIMARY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:956-523-0429
Mailing Address - Street 1:1506 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5906
Mailing Address - Country:US
Mailing Address - Phone:956-523-0429
Mailing Address - Fax:956-725-1694
Practice Address - Street 1:1506 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5906
Practice Address - Country:US
Practice Address - Phone:956-583-4620
Practice Address - Fax:956-583-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty