Provider Demographics
NPI:1619755998
Name:PATRIOT VITA CARE LLC
Entity Type:Organization
Organization Name:PATRIOT VITA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-748-9143
Mailing Address - Street 1:PO BOX 37446
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-0446
Mailing Address - Country:US
Mailing Address - Phone:210-748-9143
Mailing Address - Fax:
Practice Address - Street 1:613 NW LOOP 410 STE 200-2012
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5507
Practice Address - Country:US
Practice Address - Phone:210-748-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care