Provider Demographics
NPI:1497810584
Name:PRIDE PHC SERVICES INC
Entity Type:Organization
Organization Name:PRIDE PHC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-390-4040
Mailing Address - Street 1:12500 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2858
Mailing Address - Country:US
Mailing Address - Phone:210-949-1303
Mailing Address - Fax:210-949-1966
Practice Address - Street 1:12500 SAN PEDRO AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2858
Practice Address - Country:US
Practice Address - Phone:210-949-1303
Practice Address - Fax:210-949-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007102251E00000X
251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1497810584OtherNPI
TX007102OtherTX DADS HCSSA LICENSE
TX007102OtherHHSC LICENSE