Healthcare Provider Details

I. General information

NPI: 1518484351
Provider Name (Legal Business Name): ST. TERESA OF CALCUTTA HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12609 DESSAU RD. LOT 313
AUSTIN TX
78754
US

IV. Provider business mailing address

12609 DESSAU RD LOT 313
AUSTIN TX
78754-1822
US

V. Phone/Fax

Practice location:
  • Phone: 512-924-0862
  • Fax:
Mailing address:
  • Phone: 512-924-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MISS SINTIA KARINA URBINA PUERTO
Title or Position: MEMBER
Credential: CNA
Phone: 512-924-0862