Provider Demographics
NPI:1205919107
Name:PRIDE HEALTH CARE SERVICES INC.
Entity type:Organization
Organization Name:PRIDE HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:210-366-4272
Mailing Address - Street 1:7410 BLANCO RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4363
Mailing Address - Country:US
Mailing Address - Phone:210-366-4272
Mailing Address - Fax:210-979-9953
Practice Address - Street 1:7410 BLANCO RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-366-4272
Practice Address - Fax:210-979-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015756251E00000X, 253Z00000X
TX008962251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184913501OtherTMHP - TEXAS PROVIDER IDENTIFIER (TPI)
TX184913501OtherTMHP - TEXAS PROVIDER IDENTIFIER (TPI)