Provider Demographics
NPI:1447841846
Name:FAITH FAMILY FRIENDS PHC
Entity type:Organization
Organization Name:FAITH FAMILY FRIENDS PHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YSAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-336-7125
Mailing Address - Street 1:17827 ABD RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1752
Mailing Address - Country:US
Mailing Address - Phone:956-336-7125
Mailing Address - Fax:
Practice Address - Street 1:17827 ABD RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-1752
Practice Address - Country:US
Practice Address - Phone:956-336-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty