1104131028 NPI number — MI CASA NURSING SERVICES HOME HEALTH LLC

Table of content: (NPI 1104131028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104131028 NPI number — MI CASA NURSING SERVICES HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MI CASA NURSING SERVICES HOME HEALTH 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:
MI CASA HOME HEALTH AGENCY
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:
1104131028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4079
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALICE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-664-3900
Provider Business Mailing Address Fax Number:
361-664-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N TEXAS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-3883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-3900
Provider Business Practice Location Address Fax Number:
361-664-3901
Provider Enumeration Date:
08/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
CASTILLO
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
361-664-3900

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 013683 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001020692 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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