Provider Demographics
NPI:1588606057
Name:SAN JOSE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:SAN JOSE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:956-728-8424
Mailing Address - Street 1:102 LAKE GENEVA
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6335
Mailing Address - Country:US
Mailing Address - Phone:956-728-8424
Mailing Address - Fax:956-728-8426
Practice Address - Street 1:102 LAKE GENEVA DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1918
Practice Address - Country:US
Practice Address - Phone:956-728-8424
Practice Address - Fax:956-728-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010699251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679711Medicare Oscar/Certification