Provider Demographics
NPI:1487242582
Name:CRUZ PRIMARY HOMECARE, LLC
Entity type:Organization
Organization Name:CRUZ PRIMARY HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-766-7253
Mailing Address - Street 1:700 E GRIFFIN PKWY STE 117
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2939
Mailing Address - Country:US
Mailing Address - Phone:956-766-7253
Mailing Address - Fax:956-766-7256
Practice Address - Street 1:700 E GRIFFIN PKWY STE 117
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2939
Practice Address - Country:US
Practice Address - Phone:956-766-7253
Practice Address - Fax:956-766-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020835Medicaid