Provider Demographics
NPI:1720384258
Name:SAN AGUSTIN HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SAN AGUSTIN HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCENA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:832-659-4648
Mailing Address - Street 1:8555 POOL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4611
Mailing Address - Country:US
Mailing Address - Phone:281-550-5394
Mailing Address - Fax:281-550-5394
Practice Address - Street 1:8555 POOL CREEK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4611
Practice Address - Country:US
Practice Address - Phone:281-550-5394
Practice Address - Fax:281-550-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health