Provider Demographics
NPI:1134231707
Name:COMPLETECARE HOME HEALTH LLC
Entity type:Organization
Organization Name:COMPLETECARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-520-7977
Mailing Address - Street 1:1112 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3244
Mailing Address - Country:US
Mailing Address - Phone:210-520-7977
Mailing Address - Fax:210-520-8114
Practice Address - Street 1:1112 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3244
Practice Address - Country:US
Practice Address - Phone:210-520-7977
Practice Address - Fax:210-520-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010623251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176694101Medicaid
TX457901Medicare ID - Type UnspecifiedCERTIFIED HOME HEALTH AGE