Provider Demographics
NPI:1376114256
Name:A SERVANT'S HEART PRIMARY HOME CARE, LLC.
Entity type:Organization
Organization Name:A SERVANT'S HEART PRIMARY HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-443-0141
Mailing Address - Street 1:5001 STAGECOACH TRAIL
Mailing Address - Street 2:SUITE R
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4548
Mailing Address - Country:US
Mailing Address - Phone:956-443-0141
Mailing Address - Fax:956-443-0125
Practice Address - Street 1:5001 STAGECOACH TRAIL
Practice Address - Street 2:SUITE R
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-443-0141
Practice Address - Fax:956-443-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05Medicaid