Provider Demographics
NPI:1659316016
Name:GREAT AMERICAN HOME CARE SERVICES HOME HEALTH LLC
Entity Type:Organization
Organization Name:GREAT AMERICAN HOME CARE SERVICES HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-727-3700
Mailing Address - Street 1:2605 N ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2258
Mailing Address - Country:US
Mailing Address - Phone:956-727-3700
Mailing Address - Fax:
Practice Address - Street 1:2605 N ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-2258
Practice Address - Country:US
Practice Address - Phone:956-727-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009491251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457880Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER