Provider Demographics
NPI:1811207848
Name:NATIONAL NURSING AND REHAB SA PEDIATRICS, LLC
Entity Type:Organization
Organization Name:NATIONAL NURSING AND REHAB SA PEDIATRICS, LLC
Other - Org Name:AMAZING CARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF TEXAS OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-822-0475
Mailing Address - Street 1:121 INTERPARK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1844
Mailing Address - Country:US
Mailing Address - Phone:210-822-0475
Mailing Address - Fax:210-822-0485
Practice Address - Street 1:121 INTERPARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-1844
Practice Address - Country:US
Practice Address - Phone:210-822-0475
Practice Address - Fax:210-822-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X
TX014065251E00000X, 251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2857732-01Medicaid