Provider Demographics
NPI: | 1447207600 |
---|---|
Name: | THREE LAC INC |
Entity Type: | Organization |
Organization Name: | THREE LAC INC |
Other - Org Name: | MISSION HOME HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO/PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | CATHLEEN |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | BETHAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 210-490-8999 |
Mailing Address - Street 1: | 13750 SAN PEDRO AVE |
Mailing Address - Street 2: | SUITE 710 |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78232-4375 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-490-8999 |
Mailing Address - Fax: | 210-546-2187 |
Practice Address - Street 1: | 13750 SAN PEDRO AVE |
Practice Address - Street 2: | SUITE 710 |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78232-4375 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-490-8999 |
Practice Address - Fax: | 210-546-2187 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-30 |
Last Update Date: | 2007-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 010455 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |