Provider Demographics
NPI:1316002165
Name:SUSAN HOMECARE INC,
Entity Type:Organization
Organization Name:SUSAN HOMECARE INC,
Other - Org Name:SUSAN RESIDENTIAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-360-9982
Mailing Address - Street 1:8426 CASCADE RIDGE DR
Mailing Address - Street 2:DRIVE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-4038
Mailing Address - Country:US
Mailing Address - Phone:210-599-2508
Mailing Address - Fax:
Practice Address - Street 1:8426 CASCADE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239
Practice Address - Country:US
Practice Address - Phone:210-630-9982
Practice Address - Fax:210-590-0866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSAN HOMECARE INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-22
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities