Organization
MIRASOL PRIMARY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YOLANDA BALDERAS R.N. (PRESIDENT)
(956) 581-1351
Entity
Organization
Contact information
Practice address
710 E GRIFFIN PKWY, SUITE C, MISSION, TX 78572
(956) 581-1351
(956) 581-2306
Mailing address
710 E GRIFFIN PKWY, SUITE C, MISSION, TX 78572-2910
(956) 581-1351
(956) 581-2306
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
006581
TX
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019600
DADS CONTRACT NUMBER
TX
01
—
006581
LICENSE NUMBER
TX
01
—
345520162
SUBMITTER ID
TX
Enumeration date
02/12/2007
Last updated
05/02/2024
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