Provider Demographics
NPI:1609165935
Name:WEST SIDE PRIMARY HOME CARE INC
Entity Type:Organization
Organization Name:WEST SIDE PRIMARY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:VERNETTE
Authorized Official - Last Name:CARRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:956-723-1856
Mailing Address - Street 1:539 N GENERAL MCMULLEN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-6262
Mailing Address - Country:US
Mailing Address - Phone:210-433-3133
Mailing Address - Fax:210-433-3177
Practice Address - Street 1:539 N GENERAL MCMULLEN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-6262
Practice Address - Country:US
Practice Address - Phone:210-433-3133
Practice Address - Fax:210-433-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care