Provider Demographics
NPI:1538296181
Name:SUN CITY ENVISION HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:SUN CITY ENVISION HEALTHCARE SERVICES, INC.
Other - Org Name:ENVISION HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:915-778-0028
Mailing Address - Street 1:8929 VISCOUNT BLVD
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5827
Mailing Address - Country:US
Mailing Address - Phone:915-778-0028
Mailing Address - Fax:915-778-0013
Practice Address - Street 1:8929 VISCOUNT BLVD
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5827
Practice Address - Country:US
Practice Address - Phone:915-778-0028
Practice Address - Fax:915-778-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195374701Medicaid
TX743117Medicare Oscar/Certification