Provider Demographics
NPI:1285653493
Name:HOME PREFERRED SENIOR CARE 9, LLC
Entity Type:Organization
Organization Name:HOME PREFERRED SENIOR CARE 9, LLC
Other - Org Name:HOME PREFERRED SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-456-2574
Mailing Address - Street 1:3180 EXECUTIVE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6837
Mailing Address - Country:US
Mailing Address - Phone:325-703-2999
Mailing Address - Fax:325-703-2997
Practice Address - Street 1:3180 EXECUTIVE DR STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6837
Practice Address - Country:US
Practice Address - Phone:325-703-2999
Practice Address - Fax:325-703-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679469Medicare Oscar/Certification