Provider Demographics
NPI:1437925732
Name:SAN JUAN PRIMARY HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:SAN JUAN PRIMARY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:210-927-7712
Mailing Address - Street 1:3165 RABEL ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221
Mailing Address - Country:US
Mailing Address - Phone:210-927-7712
Mailing Address - Fax:210-927-7713
Practice Address - Street 1:545 MOURSUND BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221
Practice Address - Country:US
Practice Address - Phone:210-927-7712
Practice Address - Fax:210-927-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health