MEDICARE: COMPLETECARE HOME HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	010623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134231707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETECARE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1112 BLANCO RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3244
Country	:	US
Telephone Number	:	210-520-7977
Fax Number	:	210-520-8114

Provider Business Practice Location Address
First Line	:	1112 BLANCO RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3244
Country	:	US
Telephone Number	:	210-520-7977
Fax Number	:	210-520-8114

Authorized Official
Title or Position	:	ALTERNATE ADMINISTRATOR
Name	:	MRS. CAROLINA REYES
Credential	:	PT
Telephone Number	:	210-520-7977

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/27/2012

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