Provider Demographics
NPI:1144890625
Name:NOVA PRIMARY HOME CARE, LLC
Entity type:Organization
Organization Name:NOVA PRIMARY HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-357-5761
Mailing Address - Street 1:711 N SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5264
Mailing Address - Country:US
Mailing Address - Phone:956-626-3366
Mailing Address - Fax:
Practice Address - Street 1:3002 N MEADOW AVE STE A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-2226
Practice Address - Country:US
Practice Address - Phone:956-626-3366
Practice Address - Fax:956-626-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care