Provider Demographics
NPI:1134303043
Name:SANTA TERESA PROVIDER ASSISTED SERVICES LLC
Entity Type:Organization
Organization Name:SANTA TERESA PROVIDER ASSISTED SERVICES LLC
Other - Org Name:SANTA TERESA PAS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENGRACIA
Authorized Official - Middle Name:DEL ROCIO
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-217-8307
Mailing Address - Street 1:9440 VISCOUNT BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7054
Mailing Address - Country:US
Mailing Address - Phone:915-217-8307
Mailing Address - Fax:915-219-8271
Practice Address - Street 1:9440 VISCOUNT BLVD STE 210
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7054
Practice Address - Country:US
Practice Address - Phone:915-217-8307
Practice Address - Fax:915-219-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623430163W00000X
TX011110251E00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011110OtherTEXAS DEPT OF AGING AND D