Provider Demographics
NPI:1851401210
Name:SUPER HERO KIDS HOME HEALTH, LLC.
Entity Type:Organization
Organization Name:SUPER HERO KIDS HOME HEALTH, LLC.
Other - Org Name:HEART TO HEART HOME CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN 320550 TX
Authorized Official - Phone:210-937-1104
Mailing Address - Street 1:8700 CROWNHILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1126
Mailing Address - Country:US
Mailing Address - Phone:210-937-1104
Mailing Address - Fax:956-971-9314
Practice Address - Street 1:8700 CROWNHILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1126
Practice Address - Country:US
Practice Address - Phone:210-937-1104
Practice Address - Fax:956-971-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X, 224Z00000X, 225200000X, 251J00000X, 253Z00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186603001Medicaid
TX677851Medicare Oscar/Certification