Provider Demographics
NPI:1184115800
Name:BRILLIANCE HEALTH CARE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:BRILLIANCE HEALTH CARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:LONGORIA
Authorized Official - Last Name:CANCINO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:956-221-0412
Mailing Address - Street 1:3117 GINGER AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3488
Mailing Address - Country:US
Mailing Address - Phone:956-221-0412
Mailing Address - Fax:
Practice Address - Street 1:3117 GINGER AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3488
Practice Address - Country:US
Practice Address - Phone:956-221-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health