Provider Demographics
NPI:1184651515
Name:TWELVE LAC INC
Entity Type:Organization
Organization Name:TWELVE LAC INC
Other - Org Name:UNIQUE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-924-6077
Mailing Address - Street 1:637 CHALMERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1628
Mailing Address - Country:US
Mailing Address - Phone:210-924-6077
Mailing Address - Fax:210-924-6106
Practice Address - Street 1:637 CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1628
Practice Address - Country:US
Practice Address - Phone:210-924-6077
Practice Address - Fax:210-924-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011026251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011026OtherHCSSA
TX011026OtherHCSSA