1215246863 NPI number — SANTANA PRIMARY HOME CARE, INC.

Table of content: (NPI 1215246863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215246863 NPI number — SANTANA PRIMARY HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTANA PRIMARY HOME CARE, INC.
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:
Provider Other Organization Name Type Code:
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:
1215246863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5419 BANDERA RD STE 703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78238-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-438-9357
Provider Business Mailing Address Fax Number:
210-438-8102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5419 BANDERA RD STE 703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-438-9357
Provider Business Practice Location Address Fax Number:
210-438-8102
Provider Enumeration Date:
09/30/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTANA
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR/PRES
Authorized Official Telephone Number:
210-438-9357

Provider Taxonomy Codes

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

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

  • Identifier: 001013148 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".