Healthcare Provider Details

I. General information

NPI: 1295447555
Provider Name (Legal Business Name): BEXARCARE PEDIATRIC HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 WESTVIEW COURT DR
CANYON LAKE TX
78133-6391
US

IV. Provider business mailing address

1552 WESTVIEW COURT DR
CANYON LAKE TX
78133-6391
US

V. Phone/Fax

Practice location:
  • Phone: 210-267-7662
  • Fax:
Mailing address:
  • Phone: 210-267-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA NICOLE GUTIERREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-267-7662