Provider Demographics
NPI:1851904882
Name:SAN ANTONIO TX CAREGIVING LLC
Entity Type:Organization
Organization Name:SAN ANTONIO TX CAREGIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-991-7836
Mailing Address - Street 1:209 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7415
Mailing Address - Country:US
Mailing Address - Phone:817-991-7836
Mailing Address - Fax:
Practice Address - Street 1:13750 SAN PEDRO AVE STE 215
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4328
Practice Address - Country:US
Practice Address - Phone:210-920-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CAREGIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care