Provider Demographics
NPI:1194854281
Name:SANTA FE HOME CARE LLC
Entity Type:Organization
Organization Name:SANTA FE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-845-3900
Mailing Address - Street 1:611 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5513
Mailing Address - Country:US
Mailing Address - Phone:915-845-3900
Mailing Address - Fax:915-845-3901
Practice Address - Street 1:611 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-845-3900
Practice Address - Fax:915-845-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA FE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014474Medicaid
TX001014375Medicaid
TX176729501Medicaid