Provider Demographics
NPI:1972099604
Name:BLACK DOG HOME CARE, LLC
Entity Type:Organization
Organization Name:BLACK DOG HOME CARE, LLC
Other - Org Name:RIGHT AT HOME SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SLOANE
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-308-9342
Mailing Address - Street 1:8700 CROWNHILL BLVD STE 706
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1132
Mailing Address - Country:US
Mailing Address - Phone:210-308-9346
Mailing Address - Fax:210-308-9352
Practice Address - Street 1:8700 CROWNHILL BLVD STE 706
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1132
Practice Address - Country:US
Practice Address - Phone:210-308-9346
Practice Address - Fax:210-308-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018533253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care