Provider Demographics
NPI:1992185714
Name:PEDIA PROS HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PEDIA PROS HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-780-7250
Mailing Address - Street 1:24123 BOERNE STAGE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9403
Mailing Address - Country:US
Mailing Address - Phone:210-780-7250
Mailing Address - Fax:210-802-4770
Practice Address - Street 1:24123 BOERNE STAGE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9403
Practice Address - Country:US
Practice Address - Phone:210-780-7250
Practice Address - Fax:210-802-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-06
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017015OtherHOME HEALTH LICENSE NUMBER