Provider Demographics
NPI:1912953845
Name:CON BRAZOS ABIERTOS, LLC
Entity Type:Organization
Organization Name:CON BRAZOS ABIERTOS, LLC
Other - Org Name:CON BRAZOS ABIERTOS HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-975-5775
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0010
Mailing Address - Country:US
Mailing Address - Phone:956-968-9595
Mailing Address - Fax:956-968-9661
Practice Address - Street 1:505 S TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6220
Practice Address - Country:US
Practice Address - Phone:956-968-9595
Practice Address - Fax:956-968-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010436251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184501801Medicaid
TX184501801Medicaid