Provider Demographics
NPI:1457492134
Name:HUNTLEIGH AT HOME
Entity Type:Organization
Organization Name:HUNTLEIGH AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF THE GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-225-7400
Mailing Address - Street 1:5024 BROADWAY ST
Mailing Address - Street 2:HUNTLEIGH AT HOME
Mailing Address - City:ALAMO HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5708
Mailing Address - Country:US
Mailing Address - Phone:210-826-6969
Mailing Address - Fax:210-826-6967
Practice Address - Street 1:5024 BROADWAY ST
Practice Address - Street 2:HUNTLEIGH AT HOME
Practice Address - City:ALAMO HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:78209-5708
Practice Address - Country:US
Practice Address - Phone:210-826-6969
Practice Address - Fax:210-826-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies