Provider Demographics
NPI:1821061987
Name:HOME CARE OF THE PERMIAN BASIN, INC.
Entity Type:Organization
Organization Name:HOME CARE OF THE PERMIAN BASIN, INC.
Other - Org Name:HOMECARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:432-570-7587
Mailing Address - Street 1:501 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5818
Mailing Address - Country:US
Mailing Address - Phone:432-570-7587
Mailing Address - Fax:432-682-9593
Practice Address - Street 1:501 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5818
Practice Address - Country:US
Practice Address - Phone:432-570-7587
Practice Address - Fax:432-682-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012911601Medicaid
TX67-7296OtherMEDICARE PART A
TX024588801Medicaid
TX121861201Medicaid
TX012911601Medicaid