Provider Demographics
NPI:1144434986
Name:MIRASOL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MIRASOL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDERAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-581-5493
Mailing Address - Street 1:710 E GRIFFIN PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2910
Mailing Address - Country:US
Mailing Address - Phone:956-581-5493
Mailing Address - Fax:956-581-2306
Practice Address - Street 1:710 E GRIFFIN PKWY STE C
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-581-5493
Practice Address - Fax:956-581-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000010619251E00000X
TX010619251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010619OtherLICENSE NUMBER