Provider Demographics
NPI:1912101023
Name:NUESTRO SAGRADO CORAZON PRIMARY HOME CARE, INC.
Entity type:Organization
Organization Name:NUESTRO SAGRADO CORAZON PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/SIGNING AUTHORITY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-9828
Mailing Address - Street 1:4811 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9793
Mailing Address - Country:US
Mailing Address - Phone:956-627-3434
Mailing Address - Fax:956-627-3699
Practice Address - Street 1:4811 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9793
Practice Address - Country:US
Practice Address - Phone:956-627-3434
Practice Address - Fax:956-627-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010559251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188469401OtherTPI
TX188469401Medicaid