Provider Demographics
NPI:1437179223
Name:BIENESTAR HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:BIENESTAR HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-599-0242
Mailing Address - Street 1:3117 MCRAE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-4181
Mailing Address - Country:US
Mailing Address - Phone:915-599-0242
Mailing Address - Fax:915-599-0243
Practice Address - Street 1:3117 MCRAE BLVD STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-599-0242
Practice Address - Fax:915-599-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010205Medicaid
TX1794281-01Medicaid