Organization
DE VINE PRIMARY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANDRINA DE ANDA (OWNER/ADMINISTRATOR)
(956) 890-0222
Entity
Organization
Contact information
Practice address
1524 N CONWAY AVE, MISSION, TX 78572-4003
(956) 890-0222
(956) 598-5999
Mailing address
3003 WISTERIA DR, MISSION, TX 78574-2074
(956) 890-0222
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
163W00000X
Registered Nurse
—
—
163WH0200X
Home Health Registered Nurse
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001032089
—
TX
Enumeration date
11/04/2021
Last updated
09/04/2025
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