1962432682 NPI number — ADVANCE HI-TECH NURSING, INC.

Table of content: (NPI 1962432682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962432682 NPI number — ADVANCE HI-TECH NURSING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE HI-TECH NURSING, 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:
LIFESPAN HOME HEALTH
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:
1962432682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6243 W IH 10
Provider Second Line Business Mailing Address:
SUITE 375
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78201-2086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-798-5005
Provider Business Mailing Address Fax Number:
210-785-6649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6243 W IH 10
Provider Second Line Business Practice Location Address:
SUITE 375
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78201-2086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-798-5005
Provider Business Practice Location Address Fax Number:
201-785-6649
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
CEO/CHAIRMAN/PRESIDE
Authorized Official Telephone Number:
210-798-5005

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 009943 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 009943 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X , with the licence number: 009943 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 009943 , registered in the state of TX ; 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: "N" .

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

  • Identifier: 207460101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208798301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208975701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207217501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 095111301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207212601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290013601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 095111303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207215901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207245602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207238102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 384312001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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