1790175594 NPI number — ACASA PERSONAL IN-HOME CARE SERVICES LLC

Table of content: (NPI 1790175594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790175594 NPI number — ACASA PERSONAL IN-HOME CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACASA PERSONAL IN-HOME CARE SERVICES 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:
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:
1790175594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4215 FRED WILSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79904-6203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-383-3462
Provider Business Mailing Address Fax Number:
915-975-8184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4215 FRED WILSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79904-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-383-3462
Provider Business Practice Location Address Fax Number:
915-975-8184
Provider Enumeration Date:
01/31/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
URIBE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
915-383-3462

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; 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: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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