Provider Demographics
NPI:1922162346
Name:ELDERCARE HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:ELDERCARE HOME HEALTH AND HOSPICE
Other - Org Name:ELDERCARE HOME HEALTH II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-399-9400
Mailing Address - Street 1:1835 S SAM HOUSTON ST
Mailing Address - Street 2:STE. C
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7250
Mailing Address - Country:US
Mailing Address - Phone:956-399-9400
Mailing Address - Fax:956-399-3553
Practice Address - Street 1:1835 S SAM HOUSTON ST
Practice Address - Street 2:STE. C
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7250
Practice Address - Country:US
Practice Address - Phone:956-399-9400
Practice Address - Fax:956-399-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023871901Medicaid
TX000084900OtherPRIMARY HOME CARE
TX000656300OtherCBA
TX023871901Medicaid