Healthcare Provider Details

I. General information

NPI: 1013023852
Provider Name (Legal Business Name): COMMUNITY HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LAKE GENEVA DR
LAREDO TX
78041-1918
US

IV. Provider business mailing address

109 LAKE GENEVA DR
LAREDO TX
78041-1918
US

V. Phone/Fax

Practice location:
  • Phone: 956-725-3888
  • Fax: 956-725-3898
Mailing address:
  • Phone: 956-725-3888
  • Fax: 956-725-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010032
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D1048177
License Number StateTX

VIII. Authorized Official

Name: CRISTINA GOMEZ
Title or Position: ADMINISTRATOR
Credential: RN, MSN
Phone: 956-725-3888