Provider Demographics
NPI:1598804148
Name:SAN JUAN PRIMARY HOME CARE AGENCY
Entity Type:Organization
Organization Name:SAN JUAN PRIMARY HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-927-7712
Mailing Address - Street 1:545 MOURSUND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3938
Mailing Address - Country:US
Mailing Address - Phone:210-927-7712
Mailing Address - Fax:210-927-7713
Practice Address - Street 1:545 MOURSUND BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-3938
Practice Address - Country:US
Practice Address - Phone:210-927-7712
Practice Address - Fax:210-927-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007530251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004434OtherLTC PROVIDER ID
TX001004434OtherVENDOR
TX001015091OtherVENDOR
TX550026860Medicaid