Provider Demographics
NPI:1144559741
Name:HEAVENLY PRIMARY HOMECARE, INC.
Entity type:Organization
Organization Name:HEAVENLY PRIMARY HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-318-1554
Mailing Address - Street 1:12042 BAIL BOND DR. SUITE 2
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-7705
Mailing Address - Country:US
Mailing Address - Phone:956-318-1554
Mailing Address - Fax:956-316-0922
Practice Address - Street 1:12042 BAIL BOND DRIVE SUITE 2
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-7705
Practice Address - Country:US
Practice Address - Phone:956-318-1554
Practice Address - Fax:956-316-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX013217251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health