Provider Demographics
NPI:1780129114
Name:STATE65 HOME CARE
Entity type:Organization
Organization Name:STATE65 HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCE-CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-426-3120
Mailing Address - Street 1:1104 S MAYS ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6773
Mailing Address - Country:US
Mailing Address - Phone:512-426-3120
Mailing Address - Fax:
Practice Address - Street 1:1104 S MAYS ST
Practice Address - Street 2:STE 101
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6773
Practice Address - Country:US
Practice Address - Phone:512-426-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health