Organization
4 GENESIS PRIMARY HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANUEL MIRANDA JR. (ADMINISTRATOR-OWNER)
(956) 348-4229
Entity
Organization
Contact information
Practice address
9700 N. 23RD ST, 9700 N. 23RD ST, MCALLEN, TX 78504-9817
(956) 348-4229
(956) 378-9975
Mailing address
9700 N. 23RD ST, 9700 N. 23RD ST, MCALLEN, TX 78504-9817
(956) 348-4229
(956) 378-9975
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3803058-01
—
TX
Enumeration date
05/04/2016
Last updated
06/23/2023
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