Provider Demographics
NPI:1982635538
Name:AFFECTIONATE HOME CARE AND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:AFFECTIONATE HOME CARE AND COMMUNITY SERVICES, INC.
Other - Org Name:AFFECTIONATE HOME CARE AND COMMUNITY SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1866-631-8855
Mailing Address - Street 1:315 N SHARY RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8208
Mailing Address - Country:US
Mailing Address - Phone:956-583-3692
Mailing Address - Fax:956-583-2627
Practice Address - Street 1:315 N SHARY RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8208
Practice Address - Country:US
Practice Address - Phone:956-583-3692
Practice Address - Fax:956-583-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009972251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-9406Medicare ID - Type UnspecifiedPROVIDER NUMBER