Healthcare Provider Details

I. General information

NPI: 1467637793
Provider Name (Legal Business Name): FERNANDEZ SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2008
Last Update Date: 01/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 JAN LN
GEORGETOWN TX
78626-7353
US

IV. Provider business mailing address

203 JAN LN
GEORGETOWN TX
78626-7353
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateTX

VIII. Authorized Official

Name: LETICIA VICTORIA FERNANDEZ
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 512-731-2335