Provider Demographics
NPI:1598747214
Name:CORPUS CHRISTI HOME CARE, INC.
Entity Type:Organization
Organization Name:CORPUS CHRISTI HOME CARE, INC.
Other - Org Name:ONE AT HOME -CORPUS CHRISTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-242-1109
Mailing Address - Street 1:8233 A LEOPARD STREET
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78409
Mailing Address - Country:US
Mailing Address - Phone:361-242-1109
Mailing Address - Fax:361-242-1157
Practice Address - Street 1:8233 A LEOPARD STREET
Practice Address - Street 2:BUILDING 2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78409
Practice Address - Country:US
Practice Address - Phone:361-242-1109
Practice Address - Fax:361-242-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003814251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018453OtherTX HEALTH & HUMAN SERVICES COMMISSION
TX025049001Medicaid