Provider Demographics
NPI:1679509533
Name:ODP MANAGEMENT LLC
Entity type:Organization
Organization Name:ODP MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-AP
Authorized Official - Phone:956-973-9700
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0267
Mailing Address - Country:US
Mailing Address - Phone:956-973-9700
Mailing Address - Fax:956-973-9788
Practice Address - Street 1:609 W 6TH ST STE 2
Practice Address - Street 2:D'ORO HOME HEALTH SERVICES
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5803
Practice Address - Country:US
Practice Address - Phone:956-973-9700
Practice Address - Fax:956-973-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009435251E00000X
251J00000X, 253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172428801Medicaid
TX009435OtherTXDADS
TX45D1032632OtherMEDICARE PART B