Healthcare Provider Details

I. General information

NPI: 1114595022
Provider Name (Legal Business Name): 247 ON SITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S ENTERPRIZE PKWY STE 114
CORPUS CHRISTI TX
78405-4120
US

IV. Provider business mailing address

226 S ENTERPRIZE PKWY STE 114
CORPUS CHRISTI TX
78405-4120
US

V. Phone/Fax

Practice location:
  • Phone: 361-353-4643
  • Fax: 361-353-4647
Mailing address:
  • Phone: 361-353-4643
  • Fax: 361-353-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HEUEL
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 361-510-6568