Provider Demographics
NPI:1396035440
Name:LIFELINE VALLEY CARE, LLC
Entity type:Organization
Organization Name:LIFELINE VALLEY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:956-283-0106
Mailing Address - Street 1:1313 W POLK AVE
Mailing Address - Street 2:# 23
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2136
Mailing Address - Country:US
Mailing Address - Phone:956-283-0106
Mailing Address - Fax:956-283-9046
Practice Address - Street 1:1313 W POLK AVE
Practice Address - Street 2:#23
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2136
Practice Address - Country:US
Practice Address - Phone:956-283-0106
Practice Address - Fax:956-283-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2856676-04Medicaid
TX2856676-05Medicaid
TX2856676-03Medicaid
TX2856676-03Medicaid