MEDICARE: BENNINGTON HOME HEALTH CARE, 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	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1326496001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENNINGTON HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	1205 N STATE HIGHWAY 123 STE 102
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-667-7068
Fax Number	:	512-269-0440

Provider Business Practice Location Address
First Line	:	1205 N STATE HIGHWAY 123 STE 102
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-667-7068
Fax Number	:	512-269-0440

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AMANDA MENCHACA
Credential	:
Telephone Number	:	254-495-8490

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	04/02/2026

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