Provider Demographics
NPI:1336528991
Name:PALOMA PRIMARY HOME CARE
Entity Type:Organization
Organization Name:PALOMA PRIMARY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-766-1836
Mailing Address - Street 1:910 E PALMA VISTA DR STE B
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-1969
Mailing Address - Country:US
Mailing Address - Phone:956-766-1836
Mailing Address - Fax:956-585-4050
Practice Address - Street 1:910 E PALMA VISTA DR STE B
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-1969
Practice Address - Country:US
Practice Address - Phone:956-766-1836
Practice Address - Fax:956-585-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care