1306103759 NPI number — ARC PRIMARY CARE, LLC.

Table of content: (NPI 1306103759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306103759 NPI number — ARC PRIMARY CARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARC PRIMARY CARE, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAPPY VALLEY HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306103759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2517 W. TRENTON RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-475-3531
Provider Business Mailing Address Fax Number:
956-475-3541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 W. TRENTON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-475-3531
Provider Business Practice Location Address Fax Number:
956-475-3541
Provider Enumeration Date:
04/23/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
TROY
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
956-475-3531

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 007568 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 014957 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , with the licence number: 014957 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)