Provider Demographics
NPI:1982137790
Name:SAN ANGEL PRIMARY HOME CARE LLC
Entity type:Organization
Organization Name:SAN ANGEL PRIMARY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:DE LA O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-621-0556
Mailing Address - Street 1:2214 EL CIELO
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9293
Mailing Address - Country:US
Mailing Address - Phone:956-621-0556
Mailing Address - Fax:
Practice Address - Street 1:860 W PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8702
Practice Address - Country:US
Practice Address - Phone:956-621-0556
Practice Address - Fax:956-443-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
TX253Z00000X
TX0184023747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty