Provider Demographics
NPI:1972786341
Name:AXIS PRIMARY HOME CARE, INC.
Entity type:Organization
Organization Name:AXIS PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-982-7770
Mailing Address - Street 1:2685 N CORIA ST STE C2
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8820
Mailing Address - Country:US
Mailing Address - Phone:956-982-7770
Mailing Address - Fax:956-982-7771
Practice Address - Street 1:2685 N CORIA ST STE C2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8820
Practice Address - Country:US
Practice Address - Phone:956-982-7770
Practice Address - Fax:956-982-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010835251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health