Provider Demographics
NPI:1972195956
Name:GDL PRIMARY HOME CARE INC
Entity Type:Organization
Organization Name:GDL PRIMARY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-267-8288
Mailing Address - Street 1:4321 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5770
Mailing Address - Country:US
Mailing Address - Phone:956-267-8288
Mailing Address - Fax:956-267-8290
Practice Address - Street 1:4321 MELISSA DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5770
Practice Address - Country:US
Practice Address - Phone:956-267-8288
Practice Address - Fax:956-267-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803313962OtherSECRETARY OF STATE FILE NUMBER