Provider Demographics
NPI:1285787168
Name:FRIENDLY HEALTH SERVICES DME, LLC
Entity type:Organization
Organization Name:FRIENDLY HEALTH SERVICES DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-618-4770
Mailing Address - Street 1:504 PECAN BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2345
Mailing Address - Country:US
Mailing Address - Phone:956-618-4770
Mailing Address - Fax:956-618-4781
Practice Address - Street 1:504 PECAN BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2345
Practice Address - Country:US
Practice Address - Phone:956-618-4770
Practice Address - Fax:956-618-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01204218332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851198-01Medicaid
TX1851198-03Medicaid
TX1851198-02Medicaid
TX7374500001Medicare NSC