Provider Demographics
NPI:1851495386
Name:VALLIC TEXAS INC.
Entity Type:Organization
Organization Name:VALLIC TEXAS INC.
Other - Org Name:ADVOCATE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-385-9500
Mailing Address - Street 1:2819 NW LOOP 410 STE B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5105
Mailing Address - Country:US
Mailing Address - Phone:210-521-1244
Mailing Address - Fax:210-521-7324
Practice Address - Street 1:2819 NW LOOP 410 STE B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5105
Practice Address - Country:US
Practice Address - Phone:210-521-1244
Practice Address - Fax:210-521-7324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLIC TEXAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008332251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160718601Medicaid