Healthcare Provider Details

I. General information

NPI: 1760034433
Provider Name (Legal Business Name): HOSANNA HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16533 SE MAIN ST
PORTLAND OR
97233-4044
US

IV. Provider business mailing address

13730 RANCH ROAD 620 N APT 112
AUSTIN TX
78717-1035
US

V. Phone/Fax

Practice location:
  • Phone: 512-731-2335
  • Fax: 971-407-3713
Mailing address:
  • Phone: 512-731-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LETICIA FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 512-731-2335