Provider Demographics
NPI:1417999087
Name:SIX LAC INC
Entity Type:Organization
Organization Name:SIX LAC INC
Other - Org Name:CARE HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:N
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-404-1500
Mailing Address - Street 1:7400 BLANCO RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4360
Mailing Address - Country:US
Mailing Address - Phone:210-404-1500
Mailing Address - Fax:210-404-1502
Practice Address - Street 1:7400 BLANCO RD
Practice Address - Street 2:SUITE 132
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4360
Practice Address - Country:US
Practice Address - Phone:210-404-1500
Practice Address - Fax:210-404-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011902251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011902OtherTDADS LICENSE