Provider Demographics
NPI:1710373345
Name:DESAVIOR HOME HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:DESAVIOR HOME HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IWUALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-414-6548
Mailing Address - Street 1:PO BOX 592312
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0165
Mailing Address - Country:US
Mailing Address - Phone:956-414-6548
Mailing Address - Fax:
Practice Address - Street 1:210 E SONTERRA BLVD
Practice Address - Street 2:APT# 1229
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3928
Practice Address - Country:US
Practice Address - Phone:956-414-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health