Provider Demographics
NPI:1891040127
Name:CATERED LIVING SA, LLC
Entity Type:Organization
Organization Name:CATERED LIVING SA, LLC
Other - Org Name:NATIONAL INDEPENDENT SENIORCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:210-822-2654
Mailing Address - Street 1:1635 NE LOOP 410
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1620
Mailing Address - Country:US
Mailing Address - Phone:210-822-2654
Mailing Address - Fax:210-822-2982
Practice Address - Street 1:18323 SONTERRA PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4353
Practice Address - Country:US
Practice Address - Phone:210-291-7770
Practice Address - Fax:210-822-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015525251E00000X, 253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care