Provider Demographics
NPI:1740055516
Name:SANTA ROSA PRIMARY HOME CARE
Entity type:Organization
Organization Name:SANTA ROSA PRIMARY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-338-9885
Mailing Address - Street 1:6985 LAGUNA DE PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-6671
Mailing Address - Country:US
Mailing Address - Phone:956-338-9885
Mailing Address - Fax:956-561-4419
Practice Address - Street 1:6985 LAGUNA DE PALMAS DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-6671
Practice Address - Country:US
Practice Address - Phone:956-338-9885
Practice Address - Fax:956-561-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty