Provider Demographics
NPI:1023479912
Name:SAINT BERNADETTE'S PRIMARY HOME CARE, LLC
Entity type:Organization
Organization Name:SAINT BERNADETTE'S PRIMARY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-431-0713
Mailing Address - Street 1:910 HIDALGO ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5816
Mailing Address - Country:US
Mailing Address - Phone:956-431-0713
Mailing Address - Fax:956-431-0708
Practice Address - Street 1:910 HIDALGO ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5816
Practice Address - Country:US
Practice Address - Phone:956-431-0713
Practice Address - Fax:956-431-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty