Provider Demographics
NPI:1578538724
Name:HOLY FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOLY FAMILY HEALTHCARE LLC
Other - Org Name:ST LUKE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NACION
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-680-2500
Mailing Address - Street 1:5405 HURLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2414
Mailing Address - Country:US
Mailing Address - Phone:210-680-2500
Mailing Address - Fax:210-680-2507
Practice Address - Street 1:5405 HURLEY DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2414
Practice Address - Country:US
Practice Address - Phone:210-680-2500
Practice Address - Fax:210-680-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009641251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457966Medicare ID - Type Unspecified